This Billing Guide outlines Virginia’s workers' compensation billing requirements and DaisyBill’s resources for filing compliant medical bills.

Billing Form Requirements

This table is a guide to DaisyBill's resources on the required forms for compliant workers’ comp medical billing in Virginia.

State-Mandated Physician Reporting Requirements

This table is a guide to DaisyBill's resources on the reporting forms required for compliant paper and electronic workers’ comp billing in Virginia.

Electronic Billing Mandate

The Virginia Workers' Compensation Commission has mandated e-billing, effective 7/1/2019, with some exceptions. This means that healthcare providers in the state will have to bill electronically as of that date. For more information see this mandate: Electronic Medical Billing 16VAC30-16.

Exemptions

1. A health care provider is exempt from the requirement to submit medical bills electronically to a payer if:

1. The health care provider employs 15 or fewer full-time employees; or
2. The health care provider submitted fewer than 250 medical bills for workers’ compensation treatment, services or products in the previous calendar year.

2. A payer is exempt from the requirements to receive and pay medical bills electronically if the payer processed fewer than 250 medical bills for workers’ compensation treatment, services or products in the previous calendar year.

Complete Bill Definition

According to the Virginia Workers’ Compensation Commission Electronic Billing Regulations, to be considered a complete bill an electronic medical bill or its supporting documents must do the following:

1. Be submitted in the correct billing format;
2. Be transmitted in compliance with the format requirements described in 16VAC30-16- 30;
3. Include in legible text all supporting documentation for the bill, including medical reports and records, evaluation reports, narrative reports, assessment reports, progress reports, progress notes, clinical notes, hospital records, and diagnostic test results that are expressly required by law or can reasonably be expected by the payer or its agent under the laws of Virginia;
4. Identify the following:

1. Injured employee;
2. Employer;
3. Insurance carrier, third-party administrator, managed care organization, or payer agent;
4. Health care provider;
5. Medical service or product; and
6. Any other requirements as presented in the Companion Guide; and

5. Use current and valid codes and values as defined in the applicable formats referenced in this chapter and the Companion Guide.

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