How to Submit Workers' Compensation Claims

Jump to Section: BestNotes Prerequisites | Option A: Claim.MD | Option B: Standard Billing Partners | State Compliance Guidelines

1. BestNotes Prerequisites (Client & Payer Setup)

Before releasing claims to your billing partner, establish the client chart and insurance profile in BestNotes.

Step 1: Client Demographics

• Open the client chart and select Edit Client (or navigate to the Detail tab).
• Verify mandatory personal details—full legal name, date of birth, birth sex, street address, and contact details—to prevent demographic scrubbing errors.

Step 2: Payer Tab Configuration

• Navigate to the Payers tab on the client chart.
• Uncheck the Cash Only box and click Add Payer.
• Select your agency's Workers' Compensation payer from the drop-down menu.
• Enter the Workers' Comp Claim / Case Number into the Member ID field (BestNotes uses Member ID as the primary policy identifier transmitted to your billing partner).

Step 3: Preliminary Claims Queue (PCQ) Release

• Click the Dollar Sign ($) icon in the top-right navigation bar to open the PCQ.
• Review pending charges. Any rows highlighted in red indicate missing data (such as provider NPIs, taxonomy codes, or ICD-10 diagnosis codes) and must be updated in the client chart.
• Select the scrubbed charges, click Process Selected, and choose Release Claims to transmit the 837 billing data to your connected billing partner.

2. Billing Partner Workflows

Because BestNotes transmits core billing data, WC-specific parameters—such as the Date of Injury, Box 1a/11 mapping, and medical progress notes—are finalized within your billing software or clearinghouse.

Option A: Claim.MD Workflow

Claim.MD uses an interactive "Flag & Fix" model to ensure medical attachments and specific field parameters are met prior to payer submission[cite: 2].

1. Initial Submission Flag:Upon receiving the claim from BestNotes, Claim.MD generates an automated reminder rejection[cite: 2]:

   REJECT: Workers comp/auto claim may require attachment. Re-submit claim to bypass this rejection.[cite: 2]

2. Open the Claim: Search for and open the flagged claim in Claim.MD[cite: 2].
3. Verify Claim Fields & Date of Injury:
   • Field 1a: Must be set to 999999999 (this is the required value for Workers' Comp/Auto claims in Claim.MD)[cite: 2].
   • Field 11: Confirm the actual Workers' Comp Claim Number is listed here[cite: 2].
   • Date of Injury / Occurrence: Verify or input the Date of Injury in the claim details panel.
4. Upload Progress Notes: At the top of the screen, select the Attachment Type and click Attach Documents to upload clinical progress notes in PDF format[cite: 2].
5. Release or Bypass: Click Save/Resubmit[cite: 2]. (If no documentation is required for the claim, re-saving it without attachments clears the rejection flag and sends the claim to the payer)[cite: 2].

Option B: Standard Billing Partners & Clearinghouses

For billing partners operating on standard EDI or paper-drop rules:

1. Review Claim in Billing Software: Locate the claim pushed from BestNotes. Verify that the Employer is mapped correctly, the Filing Indicator is set to Workers' Compensation, and the Date of Injury is populated in the claim header.
2. Attach Clinical Documentation: Follow your billing software's document management steps to link required clinical progress notes or initial medical reports to the claim file.
3. Transmit or Print:
   • Electronic Submission: Send the claim bundle electronically if your billing partner and the target WC payer maintain an active electronic connection.
   • Paper Submission: If the WC payer does not accept electronic clearinghouse files, print the CMS-1500 form generated by your billing software and mail it alongside the printed progress notes directly to the claims adjuster.

3. State Requirements & Compliance

Always verify required documentation and filing timelines with your state Workers' Compensation Board or the client's claims adjuster.