Medical Billing FAQs
To be considered a complete statement for services, providers must include charges on a proper billing form (CMS HCFA-1500 or UB-92) with medical records substantiating charges attached. Bills may be submitted to KEMI via electronic submission through our clearinghouse, WorkCompEDI, or by mail.
- To submit a bill electronically, use either of the following payer IDs:
- CQ834 “Kentucky Employers’ Mutual Insurance”
- LS589 “KEMI”
- Mailed submissions may be sent to the following address:
P.O. Box 14808
Lexington, KY 40512-4808
KEMI has 30 days from the date we receive a medical bill to review the bill and release the EOR/Payment to the provider. Please allow time for initial mailing/submission, the 30-day review, and the EOR/payment mailing/submission. Bill status requests should be limited to bills that do not appear to be processing within the timeframe outlined here. Requests may be submitted to our secure email address: email@example.com. Please allow three business days to receive a response.
All bills should be submitted to KEMI within 45-days from the date of service. If a bill is not submitted timely, a provider may include a note on their billing form “Proof of Timely Filing Attached” along with documentation outlining proof of timely filing based on their records (i.e. screenshots of internal system notes showing when billing info was received, a memo outlining reason for late billing, etc). KRS 342.020 requires any provider who renders services for Kentucky workers’ compensation patients to submit a complete bill with medical records to the payer within 45-days from the date of service. However, KEMI understands that sometimes providers may not receive accurate billing information from the patient or employer when treatment is initiated, and we work with our providers to take those situations into consideration.
KEMI partners with Zelis Payments to offer an array of payment delivery options ranging from mailed checks with Explanations of Review to 835 Clearinghouse payments with online portal look-up access for EOR information. If you would like to discuss your payment delivery options, or if you have questions about your end of year 1099, contact Zelis at 877-738-8070.
If a bill was denied because it was not related to the work injury or the patient’s workers’ compensation claim with KEMI was determined to be non-compensable, medical providers should follow up with the patient to determine the best alternate payment method. However, if the bill was reduced due to late billing or due to reductions outlined in the schedule of fees, the provider may not bill the patient and should write off the balance. Per KRS 342.035(2) no provider of medical services shall collect or attempt to collect the payment of any charge for services covered by a workers’ compensation insurance plan for the treatment of a work related injury or occupational disease, in excess of that provided by the schedule of fees.
Managed Care Network FAQs
All referrals must be made within the OMCA network, unless the required specialty is not available within the network or in an emergency. Referrals to providers who are outside the OMCA Network shall be done only with the prior approval of OMCA or KEMI.
Treating a Workers’ Compensation Patient FAQs
KEMI requires an initial treatment plan at the first visit and copies of work-status orders and office visit notes for patients at each follow-up visit.
For guarantee of payment and to expedite treatment, KEMI suggests providers request pre-authorization for treatment including but not limited to: referrals to a specialist, diagnostics, therapy, invasive or surgical procedures, in-office dispensing of medications, orders for durable medical equipment. KEMI utilizes vendor partners to facilitate the scheduling of diagnostics and dispensing of durable medical equipment as a courtesy to our providers and injured workers.
Orders for procedures should include the physician’s signature, copies of diagnostics and OR Reports.
Referrals for pain management require a completed Pain Management Referral Treatment Plan.
Treatment Plans, Work Status Orders, Treatment Requests, and Medical Records may be faxed to 859-425-7822.
Kentucky has adopted the ODG Pharmacy Drug Formulary and ODG State Treatment Guidelines.
While we recognize each patient’s needs are unique, KEMI partners with our Utilization Review vendor in referencing the ODG guidelines published by MCG for guidance on evidence-based best practices for treatment of workers’ compensation claims.