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Virginia Workers' Comp Enters New Century

The Virginia Workers' Compensation Commission (VWCC), in its hundredth year of operation, will enter the 21st century as of next week.

Effective July 1, 2019, the VWCC will require all providers to electronically transmit workers’ compensation medical bills; payers, in turn, must electronically accept and respond to these bills.

Woohoo!

Electronic Requirements

Virginia state law (16VAC30-16-50) will require health care providers to “implement a software system capable of exchanging medical bill data,” with the ability to:

  • Submit electronic medical bills and documentation
  • Receive acceptance or rejection acknowledgments from payers
  • Receive electronic remittance advices

Correspondingly, payers in the state must now:

  • Accept electronic medical bills
  • Respond with electronic acknowledgments
  • Send electronic remittance advice
  • Receive electronic documentation required for bill adjudication

For more details on electronic billing as implemented by the VWCC, review the Virginia Electronic Medical Billing Regulations (PDF).

Electronically transmitted bills remain subject to Virginia’s other billing requirements. For additional information on Virginia’s workers’ compensation billing rules please refer to DaisyBill’s Virginia Billing Guide and the Virginia Medical Fee Schedule.

Timeframes

Although Virginia is implementing electronic billing, the state failed to update the payment timelines for electronic bills. Payment deadlines remain the same for bills transmitted electronically and on paper: 60 days for uncontested bill payment and 45 days for notification of denial.

This extended payment timeframe is absurd considering the near-instant speeds of e-billing. With the adoption of electronic workers’ comp billing, other states typically decrease the number of allowed days for payment. For example, in California if a provider submits a bill electronically, state law requires payment within 15 working days compared to paper billing where payment is due either within 45 days or 60 days depending on the type of payer. The VWCC should consider similar regulations.

Exceptions

There are some exceptions for payers and providers processing lower volumes of workers’ compensation medical bills. The electronic billing mandate does not apply if, in the last calendar year, a provider or payer processed fewer than 250 workers’ comp medical bills. Furthermore, providers with fewer than 15 full-time employees are also exempt from the mandate.


Thousands of workers’ comp professionals use DaisyBill’s Revenue Cycle Management software to compliantly process electronic bills in a flash. To learn more, schedule a no-pressure demo with one of our billing experts.

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