How to Verify Physical Therapy Benefits for a Worker’s Compensation Case

Verifying benefits for a worker’s compensation case is very similar to verifying commercial insurances. The major difference is the information you will need to collect from your patient.

Just like commercial insurance, you will need the patient’s name, date of birth, what they are seeking treatment for and the name of the insurance company – in the case of worker’s compensation, it is usually called the carrier. 

You will also need the following:

• The date of injury 
• Condition/body part injury
• Instead of an ID number you will need the Case or Claim number
• Name, phone number and email address of an adjuster or claim manager. The patient’s case is usually assigned to an adjustor or case manager so you’ll need his/her contact information.
• Ask the patient if they’ve had previous treatment 
• Employer information

Getting in touch with the case manager or adjustor is sometimes tricky. A lot of times they don’t answer their phone number and don’t call you back.

Once you get in touch with the case manager or adjustor you will want to ask the following questions:

1. Is the claim open for the body part the patient wants treated?
2. Is a referral required for your service?
3. Is authorization required for this case?
   1. If yes, how is it obtained?
4. What is the billing address?

For worker’s compensation, you usually are required to use paper billing with the medical notes attached. If a referral is required you may want to include this with the first visit. If authorization is required it is advised to wait until you have authorization to send the bills to ensure proper payment.

If you need help verifying your patients’ benefits, One Body can help! Clinics just like yours outsource verification of benefits to us so they don’t have to wait on hold or deal with interpreting the information given by payers. One Body does that for you. We provide you with a comprehensive, easy to understand benefits report so you know everything about the patient’s responsibility and the payer’s reimbursement requirements before seeing the patient. Fill out the contact form below or email us at hello@onebodywellness.com for more information!