North Carolina
Industrial Commission

MEMORANDUM

Due to limited staff and budget restrictions, our Medical Fees Section is experiencing difficulty processing medical bills that are being submitted with insufficient or inaccurate information. In addition, bills are being submitted that should be handled directly by the carrier or processor. The following are some specific examples and what needs to be done to rectify the situation.

·       Bills are submitted with no Industrial Commission file number. This number is assigned upon receipt of the First Report of Injury. It is the carrier’s responsibility to ensure that medical processors obtain this number. At no time should a bill be submitted to the Medical Fees Section without this number.

·       Bills cannot be processed if they are illegible. It is the carrier’s responsibility to ensure that the bills are legible before they are submitted for processing.

·       Bills for unlisted procedures are being submitted without the required medical reports. These bills cannot be processed. It is the carrier/processor’s responsibility to see that the required information is submitted at the same time as the bill.

·       Certain types of bills are processed and paid directly by the carrier. The following bills should not be submitted to the Industrial Commission: travel, prescription drugs, ambulance services, out-of-state providers, minor medical bills, private duty nursing, nursing homes and services paid per agreements (e.g. industrial rehabilitation, work conditioning or hardening, pain clinics).

·       Claimants are submitting travel and prescription drug reimbursement forms/receipts to the Medical Fees Section. It is the responsibility of the carriers to advise claimants of the proper procedures to file for travel and drug reimbursements.

·       If claims are transferred to a different carrier or third party administrator, you must provide the following information to our Statistics Section: (1) a list of claims being transferred with the IC file numbers and (2) the name and code number for the new carrier or third party administrator.

The limited staff available in the Medical Fees Section and the tight budget make it impossible for us to be responsible for tracking down the omitted information or mailing back incomplete and erroneously filed documents. We strongly solicit your cooperation in ensuring that the necessary information and correct documents are filed with the North Carolina Industrial so that claimants, providers and employers can be well served. Again, thank you for your cooperation in these matters.