Collect Claim Information
Ask for:
- Employer name
- Date of injury
- Insurance carrier or claims administrator
- Claim number (if available)
- The body part or condition related to the injury
Maryland Workers' Compensation
Treating Workers’ Compensation Patients in Maryland
A quick guide to utilizing Workers' Compensation.
4 Step Quick Start Guide
To Treating a Workers’ Compensation Patient
Provide Clinical Evaluation and Treatment
Evaluate and treat the work-related condition.
Document the Injury
Include clinical findings, diagnosis, and treatment plan related to the workplace injury.
Submit Billing
Submit a CMS-1500 claim form to the insurer responsible for the claim.
Treating workers’ compensation patients is similar to treating other patients
The main difference is how claims are documented and billed.
Claim Documentation
What To Document
Workers’ compensation claims are tied to a specific workplace injury. Medical documentation helps establish the injury, support treatment decisions, and ensure services can be billed correctly.
- How the injury occurred (patient description of the workplace incident)
- The body part or condition being treated
- Clinical findings and diagnosis
- Treatment provided or recommended
- Any work restrictions or follow-up care
Clear documentation helps insurers understand the treatment and helps support payment for the services provided.
Focus Documentation On the Work Injury
Workers’ compensation claims are typically associated with a specific injury or body part reported in the claim.
Documentation should generally focus on:
- the work-related injury
- symptoms associated with that injury
- treatment necessary for recovery from that injury
If other unrelated conditions are identified, they may need to be addressed outside the workers’ compensation claim.
Why Documentation Matters
Well-documented medical records help:
- support medical necessity for the services billed
- reduce billing disputes
- provide documentation if the claim is reviewed by insurers or the Commission
Clear, focused documentation helps both the patient and the provider by making the claim easier to process.
How Billing Works
Workers’ compensation medical services are billed directly to the insurance carrier responsible for the claim, not to the patient.
Submit the medical bill
Most services are billed using the CMS-1500 claim form (version 02/2012).
Include:
- patient and claim information
- dates of service
- CPT or procedure codes
- charges for the services provided
Send the claim to the insurance carrier or claims administrator handling the workers’ compensation claim.
Many services are reimbursed according to the Maryland Workers’ Compensation Medical Fee Guide.
Include supporting documentation
Claims should include documentation from the patient’s medical record when appropriate, such as:
- clinical notes
- diagnostic findings
- procedure documentation
Clear documentation helps insurers process the claim and reduces payment delays.
If payment is denied or delayed
If payment is refused or disputed, providers may file a Claim for Medical Services (Form C-51) with the Maryland Workers’ Compensation Commission.
The filing typically includes:
- the CMS-1500 bill
- supporting documentation
- correspondence with the insurer
The Commission may review the claim and issue an order directing payment if the services are allowed.
Billing deadline
Medical bills should generally be submitted within 12 months of the later of:
- the date services were provided
- the date the claim was accepted
- the date the Commission determined the claim was compensable
Frequently Asked Questions
Can I see a patient if they don’t have a claim number yet?
Yes. Patients seeking care for a workplace injury may not always have a claim number when they first contact your office.
You can collect basic information such as:
- employer name
- date of injury
- insurance carrier (if known)
Your office can often verify claim details with the employer or insurance carrier after the visit.
Do I bill the patient for workers’ compensation treatment?
No. Workers’ compensation medical services are billed to the insurance carrier responsible for the claim, not to the patient.
Providers typically submit a CMS-1500 claim form to the insurer handling the workers’ compensation claim.
How long does payment take?
Payment timelines can vary depending on the insurance carrier and whether the claim is accepted and processed without dispute.
When a claim is properly submitted with the required documentation, insurers generally process payment according to Maryland workers’ compensation reimbursement rules and fee schedule guidance.
If payment is delayed or disputed, providers can pursue payment through the Workers’ Compensation Commission medical claim process, including filing a Claim for Medical Services (Form C-51).
What if the insurance carrier does not pay my bill?
Maryland provides a process for providers to pursue payment.
If payment is refused or disputed, providers may file a Claim for Medical Services (Form C-51) with the Workers’ Compensation Commission.
The Commission can review the claim and may issue an order directing payment if the services are allowed.
Do I need prior authorization to treat a workers’ compensation patient?
Authorization requirements can vary depending on the insurance carrier and the type of service being provided.
If authorization may be required, providers should confirm requirements with the insurer or claims adjuster responsible for the claim.
What documentation is required?
Documentation should clearly describe:
- the workplace injury
- the body part or condition being treated
- clinical findings and diagnosis
- treatment provided or recommended
Documentation generally focuses on the work-related injury associated with the claim.
Do providers need to testify in hearings?
Most treating providers participate in workers’ compensation claims through their medical records and documentation, not through in-person testimony.
In some cases, a provider may be asked to provide clarification about treatment or documentation related to the claim. When that happens, it is typically coordinated through the parties involved in the case.
For many claims, medical records alone provide the information needed.
Who can I contact if I have questions about billing or claims?
Providers with billing or medical fee schedule questions may contact the Workers’ Compensation Commission Medical Section.
They can help answer questions about billing procedures and claim payment issues.
Need Help With Your First Workers’ Compensation Patient?
Practices sometimes hesitate to accept workers’ compensation patients because the first claim feels unfamiliar. Provider support can help with:
- Authorization Questions
- Billing Guidance
- Documentation Questions
Contact us
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