As your partner, we want to be considered a “department down the hall”. From registration to reimbursement, our proprietary claims management software along with a team of workers’ comp reimbursement specialists will work towards hitting the financial goals you identify as having the most impact to your specific organization. Our proprietary contract management software, repricing and payer pathway tools allow us to deliver your bills to the right payer, get them paid timely and ensure that you get the maximum amount you’re owed.

Here are the cornerstones of our program:

• Payer verification: We use our proprietary tools to make sure your bills go to the right place the first time. Our experience has shown that the large majority of Workers’ Comp hospital bills are initially sent to the wrong place.
• Bill pre‐packaging: Workers’ Comp payers often require significant supporting documentation to approve bills for payment. We match the bills with medical records, itemized statements, implant invoices and analysis prior to sending to the payer.
• Electronic billing: EnableComp has plug and play solutions with claims clearinghouses that accommodate electronic submission of attachments together with the bill. Use of E-billing typically improves days-to-pay significantly over paper bill submissions.
• Persistent telephone follow‐up: Workers’ Comp payers simply will not pay most hospital bills by paper bill submissions alone. We provide aggressive telephone follow‐up beginning as soon as seven days after bills are submitted.
• Thorough payment review: To ensure proper payment, all EOBs must be reviewed and amounts compared on a line‐item level. Our proprietary tools allow our Revenue Specialists to efficiently identify and appeal virtually all underpaid items.
• Denial management: We quickly identify claims that are denied as not related to a work injury and provide the documentation necessary for the hospital to promptly pursue reimbursement from the patient or their health insurer.
• Front‐end contractual adjustments: Our contract management and repricing software allows us to identify state fee schedule and PPO contractual adjustments as soon as your data is passed to us. We return contractual adjustment amounts to you so that your trial balance can reflect actual amounts due within a few days of billing.
• Policy Advisement Group: The Managed Care department provides subject matter expertise for client hospitals for a variety of topics such as regulatory policies, contract management, and payer behavior. The team serves as the liaison between EnableComp and State Government and ensures compliance with reimbursement law.

The first step in being able to recover underpayments is knowing what payment to expect. Changing fee schedules and inconsistent remit data make it difficult to identify underpayments. Our team has a level of expertise allowing them to recover cash you’ve already written off based on their experience with individual state and USDOL rules.

EnableComp’s zero balance program provides a solution to recover these lost dollars. Here’s what differentiates us:

• Enforcer360 (our proprietary technology): The first step in being able to recover underpayments is knowing what payment to expect. Our agile technology generates a comparative expected reimbursement and identify underpayments. Enforcer automatically updates to reflect all current state fee schedules, as well as historical data to allow accurate review of claims that are several years old.
• Workers’ Comp specialists: Our CompRecover team has specialized expertise in working with payers in this unique and complicated reimbursement class. Their only focus is workers’ comp denials and underpayments. This team’s knowledge of states’ rules and dispute resolution processes (including USDOL) ensures the success of the cash recovery process.
• Professional support: We employ nurses and certified coders to support our team’s review and appeal process of improper payer denials.
• State Workers’ Comp Bureau communication: Our relationships provide clarification to many gray areas and help us avoid most formal disputes with payers.

Workers’ comp claims tend to reach a tipping point where the resources required to collect become costlier than the potential reimbursement itself. In this instance, organizations can pass off stingy open A/R to EnableComp. Upon receipt, workers’ comp specialists will scrub the claim to identify where the snag is, correct it and resubmit and/or appeal on your behalf.

Payer Verification and Review: EnableComp uses Enforcer360, our proprietary software to identify the correct payer and address for bill submission to ensure that bills are going to the right place the first time to expedite payment to your facility. To ensure proper payment, all EOBs must be reviewed and accounts compared on a line-item level. Enforcer, allows our Revenue Specialists to efficiently identify and appeal virtually all underpaid items.

Denial Management: We quickly identify claims that are denied as not related to a work injury and provide the necessary documentation for your facility to promptly pursue reimbursement from the health insurer or the patient.

Status Documentation: Weekly text-based collection notes files can be uploaded into your hospital database to ensure that patient account status are updated.

Many payers are increasing their reliance on third parties to settle larger hospital claims that fall outside of their PPO networks. These companies offer faster payment in return for significant discounts. Knowing when to accept these offers and negotiating the best rates can be challenging for hospitals, particularly when there is no state fee schedule or prescribed amount due. EnableComp’s team of experienced Workers’ Comp specialists utilize their knowledge base to negotiate the best rate possible. Our negotiated settlements program will also determine whether accepting an offer is in your best interest. There’s no risk on your part; our fees are only a portion of the increased rates we negotiate. Just send us the payer’s discount proposal and we typically resolve the claim within a few days.