UTP Business Operations Procedure Manual - Revision Date: 11/06/02

Policy Title: WCI Case Set-up Procedures for Clinical and Departmental

Policy Statement: This procedure is used to set up complete WCI case billing information for inpatient/outpatient services rendered at Memorial Hermann Hospital/LBJ and UTP facilities.

Description of WCI Billing: WCI cases are a means of grouping invoices that are related to an episode of care. The system views a case as a single unit. This enables the user to analyze financial information within a case and to compare information among cases. Each WCI case setup is associated with a case type that categorizes the case for reporting and billing purpose. A case type consists of a name, number, mnemonic, a reporting category and a billing class.

• Click here for the Worker's Compensation Insurance Verification Form
• WCI Representative (Per'se)

Detail Procedures:

I. WCI Case Set-up Procedure

• Specialist physician office receives a call for a worker's compensation case appointment.
• Office obtains all necessary information over the phone.
• An office personnel completes worker's compensation insurance verification form.
• WCI representative verifies injury/claim information and sets-up case in IDX.
• WCI representative forwards case # (insurance verification form) back to requestor within 48 hours or prior to patient appointment.

  Verification form example: See appendix 1

II. Case Registration for Clinical and Departmental

Once the patient has been registered, the clinic personnel will need to view the case registration screen to see if an "I" or injury case is set up. If not, the clinic should forward the WCI information by email or fax to the Insurance Services WCI department for handling using the WCI verification form (example 2 ).

III. Charge Entry

When you've already identified that the patient is WCI and that the charges need to be billed to the Worker's Compensation Carrier, your charges will need to be entered accordingly.

• Once all the necessary things has been done to begin entering your charges (generate a batch number, completing the header information, registration info etc.) and you are on the detailed portion of the charge entry screen, you will need to go to the "Case" field.
• You will enter a "?" in this field if you are unsure what the case number is. If a case is set up, the system will display them and ask you "Which one of these is the entry?"
• You will then select the appropriate case, if more than one is listed, you will select the "I" type case with your Date/Type of Injury.
• When you enter your procedure code, diagnosis, modifier, etc, you will make sure that the invoice FSC is listed as "6002". If it is not listed as this, please change.
• Once you have finished entering your information, press F10 to save your invoice.

Click here for the Worker's Compensation Insurance Verification Form.