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Provider Manual

Workers Compensation

Last Updated on August 28, 2018

  • Family Health Center does not cover the cost of services covered by a Workers’ Compensation carrier. Claims that are determined to be work-related will be denied using ANSI code 19. The denial reason will print on the affiliated provider’s reimbursement statement. Claims must be submitted to the Workers’ Compensation carrier first. 
  • If claims have already been paid by Family Health Center, related charges will be reversed. The adjustment will be reflected on the affiliated provider’s reimbursement statement, using ANSI 19. 
  • If the affiliated provider is overpaid due to payment from the Workers’ Compensation carrier, the affiliated provider should complete an adjustment request form and send it along with a copy of the original claim and a copy of the Explanation of Benefits from the Workers’ Compensation carrier. Family Health Center will reverse charges. The adjustment will be reflected on the affiliated provider’s reimbursement statement. 
  • If the Workers’ Compensation carrier denies a claim, Family Health Center will consider payment if a copy of the denial is attached. The affiliated provider must submit within 180 days from the date of the Workers’ Compensation carrier denial.  Family Health Center may also pursue directly with Workers’ Compensation or an attorney if one has been retained.
  • If the affiliated provider has any questions regarding Workers’ Compensation, please call 715-221-9503 or 1-800-548-4831, Monday through Friday between 8 a.m. and 4:30 p.m. or email shpcob@securityhealth.org