Can You Outsource Workers Compensation Billing and Authorizations?
Dedicated HIPAA-trained teams verify claim numbers and adjusters, prepare treatment authorization requests, bill against state fee schedules, follow up bill-review reductions, and work your AR with carriers, state funds, and claims administrators, inside your own PM system. Flat weekly pricing from $299 per FTE (volume based), with a trained backup included at no charge. Live in 14 days.
Workers Compensation Is Not Health Insurance
Workers compensation runs on each state’s own system, with its own fee schedules, billing forms, filing deadlines, and dispute steps, so the rules that govern a claim come from the state where the injury occurred, not from a plan document. Many states accept the CMS-1500, while some state systems require their own billing forms and portals. The payers split four ways: private carriers such as The Hartford and Travelers, competitive state funds that sell coverage alongside private carriers, such as NYSIF, Texas Mutual, California’s State Fund, and Pinnacol, monopolistic state funds in Ohio (BWC), Washington (L&I), North Dakota (WSI), and Wyoming, where there are no private carriers and the state fund is the only workers comp payer, and claims administrators such as Sedgwick and Gallagher Bassett, which process claims on behalf of carriers and self-insured employers. For your desk the practical rule: the employer tells you who administers the claim, and that administrator’s state sets the rules.
The Workers Comp Work Your Team Does, We Staff
Claim-Number and Adjuster Verification, the Workers Comp Eligibility Check
There is no insurance card to scan on a workers comp visit, so our specialists build the account the way a comp desk has to: before the visit they confirm the claim number, date of injury, employer of record, the carrier, state fund, or claims administrator handling the claim, and the adjuster’s name and direct contact, then document which body parts and conditions the claim accepts, because treatment outside the accepted conditions is where payment problems start. When a patient arrives with an injury story and no claim details, we call the employer and the administrator to establish the claim before the encounter turns into an unpaid account. This is the same discipline behind our dedicated workers compensation coverage verification service: your team hands us the schedule, we hand back verified claims with the adjuster on record.
Treatment Authorization Request Support, State by State
Most state systems require authorization before non-emergency treatment moves past the initial visit, and the request runs through the claim’s administrator under the state’s utilization review rules. Our specialists handle the administrative side of that pipeline: they assemble the request with the clinical documentation your providers supply, submit it on the form or portal the state and administrator require, some states use standardized request forms, such as California’s Request for Authorization, calendar the state’s response deadlines, chase the determination with the adjuster or the utilization review vendor, and log the authorization decision on the account where billing will find it. Medical necessity decisions stay where they belong, with your providers and the reviewers; what we remove is the form preparation, the submission tracking, and the follow-up calls that otherwise land on your clinical staff between patients. When a request stalls past the state’s decision window, we escalate it through the administrator’s own channels and document each touch.
State Fee Schedule Billing Support
Our billers prepare workers comp bills against the correct state’s requirements inside your own PM system: the right form, many jurisdictions take the CMS-1500 while some state systems require their own forms or portal submission, the right supporting documentation, comp payers routinely require the treatment notes attached to the bill, and the right expectations, because the allowable comes from the state’s fee schedule, not from your commercial contracts. Monopolistic states change the routing itself: Ohio BWC medical billing runs through the claim’s managed care organization, and Washington L&I is billed directly as the single payer under its own rules. We track those routing differences per account so the bill leaves correctly the first time. This is work we already deliver as a dedicated service through our workers compensation medical billing service, alongside the rest of your revenue cycle, at the same flat weekly fee.
Bill-Review Dispute Follow-Up
Nearly every workers comp bill passes through a bill-review process before payment, and the result arrives as an explanation of review that states what was allowed, what was reduced, and why. Our specialists read each explanation of review against the state fee schedule and the authorization on file, and when a reduction is wrong, a miscoded fee schedule line, a service reduced despite an authorization, documentation the reviewer says is missing but was sent, they prepare the administrative response: the reconsideration or second-review request the state provides, filed on the state’s form within the state’s deadline, with the supporting documentation attached. Disagreements that survive that step move into the state’s own dispute process, and we keep the paper trail organized so your practice can decide, with proper guidance where needed, whether a given dispute is worth pursuing. What changes for your team is that reductions get answered on time instead of written off because nobody had an afternoon to fight them.
AR Follow-Up Against Carriers, Funds, and Claims Administrators
Workers comp AR ages differently than commercial AR: the claim may be under investigation, the adjuster may have changed without notice, the administrator may be waiting on documentation nobody told you about, and none of that surfaces until someone calls. Our AR specialists work comp aging as a standing queue, statused with the administrator on a cadence, documented touch by touch, and escalated when a state’s prompt-payment rules for accepted claims are being missed. We report production daily, and you can review our activity in your own system. Accounts tangled in claim disputes or litigation holds are flagged and handled through our dedicated complex claims service, which exists because these accounts need patient, organized administrative follow-up rather than another pass through the standard queue. The result is the change every comp practice wants: the oldest, hardest slice of the aging gets owned daily instead of touched quarterly, at a flat weekly fee that does not change with what we recover.
Put a Dedicated Specialist on Your Workers Comp Queues
Claim verification, authorization requests, state-fee-schedule billing, bill-review disputes, and comp AR, owned daily by a trained team inside your own systems, at a flat weekly fee. Meet us, pick the seats you need, and watch the work move before you commit to anything.
Book Your 2-Week Free TrialThe Carriers, State Funds, and Claims Administrators Your Practice May See
The workers comp payers from our payer master. Whichever of these administers your patient’s claim, the five workflows above are the same discipline applied to that jurisdiction’s rules.
Carrier, state fund, and claims administrator names are the property of their respective owners and are shown here only to identify the payers practices bill. No affiliation with or endorsement of Staffingly, Inc. is implied.
Flat Weekly Pricing Per Dedicated Specialist
1 to 4 dedicated payer-desk FTEs.
5 to 9 FTEs.
10+ FTEs.
45 hours of coverage for less than others charge for 40.
$399 per week works out to $8.87 per hour across 2,340 hours of coverage a year, flat. Your dedicated specialist covers a 9 hour day, Monday to Friday, a full hour more than a standard shift: the day starts by clearing what arrived after you closed, adjuster callbacks, explanation-of-review batches, and the morning claim verification list, and it ends past your close so far less rolls into tomorrow. A trained backup steps in at no charge whenever they are out. Flat weekly fee per dedicated specialist, never a percentage of your collections, no setup fees.
Start with a 2-Week Free Trial. Month-to-month after, with no long-term contract.
- Salary + payroll taxes + benefits
- Recruiting + turnover replacement
- Training on your payers + PM system
- PM seat + equipment + PTO coverage
Calculate Savings
Workers Comp Billing: Real Questions From the Desk
How do we verify coverage when a workers comp patient has no insurance card?
Verify the claim, not a card: the claim number, date of injury, employer of record, the carrier or claims administrator handling it, and the adjuster’s contact. The employer or its administrator confirms these. Until the claim is established and the accepted conditions are known, treatment past the initial visit is financial risk.
Do we bill workers comp on a CMS-1500 or a state form?
It depends on the jurisdiction. Many states and administrators accept the CMS-1500, often with treatment notes attached, while some state systems require their own billing forms or portal submission. Check the rules for the state where the injury occurred, not where your practice sits, and confirm the administrator’s documentation requirements before the first bill.
Who authorizes treatment on a workers comp claim?
The claim’s administrator, a carrier, state fund, or claims TPA, under the state’s utilization review rules. Requests are typically submitted with clinical documentation on the state’s or administrator’s required form, and the state sets response deadlines. Get the authorization decision in writing and on the account before the service is scheduled.
Why did the payment come back lower than what we billed?
Workers comp pays from the state’s fee schedule, not your charges or your commercial contracts, and most bills also pass through bill review, which can reduce lines further. The explanation of review states what was allowed and why. If a reduction misapplies the fee schedule or ignores an authorization, most states provide a reconsideration or second-review step with a deadline.
What is an explanation of review, and how is it different from an EOB?
An explanation of review, or EOR, is the workers comp counterpart of an EOB: the bill-review result showing what the payer allowed, reduced, or denied against the state fee schedule, with reason codes. Unlike an EOB, it reflects a state fee schedule and the claim’s accepted conditions, and it is the document your dispute deadlines run from.
Can we bill the patient for the balance on a workers comp claim?
On an accepted claim, generally no. State systems prohibit billing the injured worker for authorized treatment of accepted conditions; payment disputes run between the practice and the payer through the state’s process. Where a claim is denied or a condition is not accepted, state rules govern what happens next, which is why verification up front matters.
What changes in Ohio, Washington, North Dakota, and Wyoming?
Those four are monopolistic states: there are no private workers comp carriers, and the state fund, Ohio BWC, Washington L&I, North Dakota WSI, and Wyoming’s program, is the only payer. Routing changes with them; Ohio BWC medical billing runs through the claim’s managed care organization, and Washington L&I is billed directly under its own forms and rules.
The claim says Sedgwick or Gallagher Bassett, but they are not the insurance company. Who do we bill?
Bill the claims administrator shown on the claim. Sedgwick and Gallagher Bassett are third-party administrators that process workers comp claims on behalf of carriers and self-insured employers, so they receive the bills, run the review, issue the explanation of review, and staff the adjuster, even though the financial risk sits with the employer or carrier behind them.
Written By
Dan Nandan has spent 25+ years in IT consulting and healthcare BPO, was among the first in the US to build an RPO/BPO delivery network overseas, and has been featured in Computerworld. He runs the operations and the dedicated virtual teams behind the payer workflows on this page, including the workers compensation billing and coverage verification services linked above.
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Claim Your 2-Week Free TrialStaffingly, Inc. is an independent provider of flat-fee administrative support. It is not affiliated with, endorsed by, or acting for any workers compensation carrier, state fund, or claims administrator named on this page, it is not a law firm or a collections agency, and it provides no clinical or legal services; medical decisions remain with treating providers and payers, and its fee is a flat weekly rate that does not vary with claim outcomes or amounts recovered. Workers compensation billing, authorization, and dispute rules are set by each state and administrator and can change; confirm current requirements with the state agency or the claim’s administrator before acting on a specific claim.