Medical E-Billing Requirements
Electronic Submission and Processing of Medical Bills
Electronic billing, or e-billing, is the exchange of electronic medical billing transactions between providers and payers in the workers' compensation system according to a set of uniform guidelines. In Tennessee, eBilling is mandatory for both payers and health care providers.
This webinar provides an accessible overview of the Tennessee eBilling mandate for workers' compensation payers and providers
Effective July 1, 2018, Tennessee Rules and Regulations 0800-2-26 requires health care providers to submit medical bills to insurance carriers, or their agents, electronically, and for insurance carriers to accept these electronic bills.
The exception to this requirement will be made automatically for healthcare providers that employee 10 or fewer employees or that submitted fewer than 120 bills for workers' compensation treatment in the previous calendar year. Exceptions will also be made automatically for insurance carriers if they processed fewer than 250 bills for workers' compensation treatment or services in the previous calendar year. Finally, if either a health care provider or insurance carrier establishes that compliance will result in an unreasonable financial burden, it may be excepted from the electronic billing requirements, as determined by the Bureau. To qualify for exemption based on the unreasonable financial burden, the organization must submit its rationale and supporting documentation to the WC.eBill@tn.gov. The rationale should be on the organization's own letterhead and addressed to the Bureau Administrator, Abbie Hudgens.
Frequently Asked Questions
Yes. The Bureau may impose a civil monetary penalty up to $500 per violation, not to exceed $5000 for identical violations per calendar year.
Absent a waiver, the eBilling rules apply to all Tennessee workers' comp claims regardless of where the treatment is given, where the provider is, where the employee or employer lives, or where the employer is located. TCA 50-6-101 states the TN WC Law is controlling for any claim for WC benefits for any injury as defined in this chapter. There are many factors relating to jurisdiction, but suffice it to say that once that's figured out, say, whether it's in Tennessee or Kentucky claim, it's fairly straight-forward.
No, not unless they have "opted in" to the workers' compensation system since, by law, they can set up their own programs to handle on-the-job injuries.