Madison, WI – The Executive Committee of the International Association of Industrial Accident Boards and Commissions recently adopted revisions of the Workers’ Compensation Electronic Medical Billing Model Rule, Version 2.1 and Workers’ Compensation Electronic Billing and Payment National Companion Guide, Release 2.1. These two products were developed to assist jurisdictions throughout the U.S. by providing a framework for electronic billing, processing, and payments for medical services and products provided to injured workers. Twelve jurisdictions have implemented or are considering eBilling initiatives.
Healthcare in the United States is rapidly being transformed by the use of standardized electronic transactions and workers’ compensation is looking to benefit from similar administrative efficiencies. Jurisdictions will benefit from the IAIABC’s eBilling tools because they are built on existing HIPAA-compliant electronic healthcare standards, conforming to the ASC X12 5010 format. “Aligning with standards in use by the general health industry is critical because providers and payers will not have to build separate systems for workers’ compensation transactions,” remarks Tina Greene, EDI Medical: ProPay Committee Chair.
The ProPay Subcommittee of the IAIABC EDI Medical Committee developed the Model Rule and Companion Guide to be used together as templates for jurisdictions to create their own eBilling Rule and Companion Guide. Electronic billing is a complex subject and the IAIABC products outline both policy considerations workers’ compensation jurisdictional agencies should consider and technical specifications to align as closely as possible with the ASC X12 format. Jurisdictions use the IAIABC Companion Guide as a template to customize to their specific electronic medical billing requirements.
The IAIABC Electronic Medical Billing Model Rule was first adopted by the IAIABC in June 2011. Revisions were made to clarify language, cross-reference the Model Rule to the corresponding section of the Companion Guide, and include standards for Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) contained in X12’s Technical Report Type 2 Reports (TR2s). TR2s help the industry move away from proprietary jurisdictional codes, paving the way for greater efficiency in the billing process. The Model Rule and Companion Guide were also updated to learn from the experience of jurisdictions that are undergoing the implementation process.
The Guide is available here: IAIABC Electronic Medical Billing Model Rule and Companion Guide (Member Login Required)