EDI FAQ of the Week
The Division of Workers’ Compensation maintains a resource page for EDI issues. Among the features on that page, the Division posts an EDI FAQ of the week. This week’s FAQ and answer:
FAQ of the week:
Q: How do I report a reconsideration workers’ compensation medical bill that has gone through a reconsideration or appeal?
A: 28 TAC §134.804(a) provides that original medical EDI records on subsequent payment actions must contain a service adjustment reason code of ‘W3’.
Please note that in addition to reporting ‘W3” on a reconsideration medical bill, another service adjustment reason code(s) must be reported when the medical service charge(s) is denied or reduced.
FOLIO
