Insurance News:

NYSIF Introduces State-of-Art Medical Bill Inquiry System

by | 10/21/2009 2:19:02 PM

The New York State Insurance Fund today announced a state-of-the-art online medical bill inquiry service with the expansion of its electronic Explanation of Benefits (EOB) for doctors treating workers’ compensation injuries covered by NYSIF. In making the announcement, NYSIF Chief Deputy Executive Director Francine James said the upgrades are part of NYSIF’s electronic medical billing and inquiry system available to all medical providers treating NYSIF claimants. “We are pleased with the upgrades we’ve made to our electronic EOB system and we anticipate that medical providers will be, too,” Ms. James said. “This system is a real time saver for doctors, their billing staffs and for our own personnel – and by including more information on screen NYSIF is introducing a state-of-the-art system for workers’ compensation medical bill inquiries.” The new EOB service gives providers a more detailed explanation of medical bill payments made by NYSIF, alerts them to bills that have not been received, or reasons why a bill hasn’t been paid. NYSIF introduced its online EOB for workers’ compensation medical providers in 2007, an Oracle based system built in-house by NYSIF system developers. The Fund followed soon thereafter with giving providers the option to submit medical bills electronically to NYSIF. The EOB upgrades are based on the most frequently asked questions received from doctors’ billing offices. The system has been a value added service, saving time and money by providing convenience for medical administrative staffs transacting business with NYSIF. According to NYSIF medical claims team, some of the more common reasons for non-payment of workers’ compensation medical bills submitted to NYSIF include pending claim status, claim disallowance, claim settlement, invalid jurisdiction, lack of proper medical records, and duplicate billing of paid procedures. All of this information is now accessible to medical providers and their staffs 24/7/365 days a year, spelled out clearly in one location for all medical bills submitted on every claim. NYSIF’s expanded electronic EOB offers an express means by which to cut wait time on billing errors, avoid payment delays and eliminate the time and resources NYSIF and doctors’ staffs devote to billing questions. Medical bill inquiries made online at provide users with NYSIF’s claim number, the claimant’s name, date of injury, complete contact information for the NYSIF case manager and office assigned to the case, the NYSIF assigned bill number, bill date, date received and bill status for every claim on record. As an insurance carrier, NYSIF assigns its own claim number to workers’ compensation claims. The New York Workers’ Compensation Board assigns a different number to the claim. NYSIF lists both numbers in the summary to avoid potential confusion for administrative personnel not familiar with the state workers’ compensation system. The summary includes billing codes, total charges and amounts paid, along with a reason why only partial payment may have been made for certain billed procedures. A short narrative summarizes the check number, amount paid, date issued and mailing address on record. Users have the option to click on the check number to see a complete explanation of payments included in the check and to print the complete EOB. The service is free to any medical provider doing business with NYSIF. Medical providers may only access the EOB for the bills they submit. By leading to less time spent on billing questions, either on the phone or exchanging e-mail, NYSIF believes the new features will further increase productivity and efficiency for medical office personnel using the system and for NYSIF staff. NYSIF, a non-profit organization of the state of New York created as part of the Workers' Compensation Law of 1914, is New York’s largest workers’ compensation insurance carrier. By law, NYSIF is a competitive insurance carrier that sells workers' compensation and disability benefits insurance to any employer doing business in New York State. Approximately 185,000 employers hold NYSIF workers' compensation insurance policies, constituting about 41 percent of the market.

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