What information should be provided with a medical bill and/or Explanation of Benefits?
Section 8.2(d) requires payers to pay bills that contain “substantially all the required data elements necessary to adjudicate the bill.” Parties may disagree over what constitutes a complete bill. We encourage payers to provide specific information about why a bill was rejected or reduced. Cite the particular document and page as the basis for the action taken, if possible. It is not appropriate to tell providers to call the IWCC to find out why a payer paid a bill as it did. We refer such behavior to the Illinois Department of Insurance. The Workers’ Compensation Medical Fee Advisory Board has discussed the issue but did not reach a conclusion. The only way to get a binding decision at this point is for the parties to take the issue before an arbitrator. Once a case is resolved and precedent set, we’ll all know more about what is required. In the meantime, in the absence of regulations, we encourage people to cooperate and to follow common conventions. How should the payer handle a b
