When a patient is currently on Workers Compensation, and he or she comes in for a complaint unrelated to the Workers Comp, is a denial required and do we need to submit that bill in hard copy?
A. A denial is not required but there must be some indication that the claim is not related to the Workers Compensation injury. For electronically submitted claims, staff will check to determine whether the diagnosis codes could be related to the Workers Compensation injury. If the relationship cannot be adequately determined, the claim will be denied and the provider will be asked to send a hard copy. The provider needs to indicate on the claim form the injury is not Workers Compensation related (field 19 on HCFA-1500; field 64 on the UB). These claims need to be submitted directly to the TPL unit at P.O. Box 5838, Helena, MT 59604.
