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Work Comp Running Through Cofinity Network

  1. #1
    Default Work Comp Running Through Cofinity Network
    Exam Training Packages
    If anyone could provide any guidance on the following issue I would really appreciate it -

    I am a biller in Michigan and have various workers comp insurances using the Cofinity network and are thus paying us at Cofinity rates instead of the workers comp rates as outlined by the State of MI. I don't think this is right but I'm not sure how to obtain the correct payment. My physician says we can fight this but I'm not sure how! Has anyone experienced this or have any solutions to this problem?

  2. #2
    Portland Metro Chapter
    In Oregon, providers must sign a special release with the WC division in order for payers to apply network discounts to WC services. Research your state's WC web site to see if such an agreement is addressed. Also, check your contract with the payer. Did they slip in language about being able to apply their discount to WC claims. We won't sign any payer contracts with this language in place.

    The only discounts we have to accept are related to MCO (Managed Care Organizations) that are associated with some WC claims.

    If your state doesn't have such an agreement, I would pursue this as it isn't fair to providers to be paid at network rates with all the extra work required for WC.

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