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Workers' comp billing in five minutes

The domain model a developer needs before submitting the first bill.

The 30-second model

A workers' comp bill combines professional claim data with supporting PDFs, sends both to the employer's claims administrator, and remains active until payment or a final resolution.

MindBill validates CMS-1500 data, generates 837P transactions, routes through Carisk, Jopari, or Data Dimensions, falls back to fax, mail, or email when needed, and normalizes the responses behind one API.

What is different from commercial medical billing

Identify a claim, not a member

Use the claim number, employer, date of injury, and claims administrator—not a health-plan member ID.

Routing is part of the problem

The same carrier may use different administrators or destinations. MindBill resolves the electronic payer ID or an explicit fallback destination.

Accepted is not paid

A 999 or 277CA can accept the transmission. The payer later returns an EOR with payment, adjustments, or denial reasons.

Billing-mode availability

professionalmed_legal
CMS-1500 treatment and other professional services for claims in all 50 states, available to organizations with treatment billing enabled. New partner-provisioned organizations receive this capability. Uses diagnoses selected for each service line.CMS-1500 medical-legal evaluations, reports, record review, and related services for claims in all 50 states where the submitted code and payer delivery route are supported. California fee-schedule calculations apply only to eligible California services.

Choose the mode for the services being billed and set the claim's actual injuryState. Treatment uses the same bill lifecycle. For CMS-1500 professional bills, select automatic schedule checks or manual pricing with explicit line charges. Supported UB-04, ADA, and NCPDP bills can also use any claim state. Confirm the payer and delivery route before submission; availability of a state code does not guarantee electronic routing to every payer. See the treatment quickstart.

The lifecycle

  1. Prepare locally: review fields and attachments in your product. No MindBill bill exists yet.
  2. Submit: one atomic request validates the complete packet and creates an immutable bill whose first state is submitted.
  3. Accepted or rejected: track transport and claim-level acknowledgements. Submit a new corrected snapshot when replacement is required.
  4. Processed: read the EOR, post payment, or inspect denial and adjustment reasons.
  5. Resolve: close the bill or pursue Second Bill Review and, when eligible, IBR.

Six terms you will see

CMS-1500
The human-readable professional claim form.
837P
The X12 electronic transaction carrying the same professional claim data.
999
An acknowledgement that the EDI envelope is syntactically valid.
277CA
Claim-level acceptance or rejection from the electronic pipeline.
EOR
The payer's Explanation of Review: payment, adjustments, and reasons.
SBR / IBR
Second Bill Review, followed when eligible by Independent Bill Review.

California details: electronic billing, IBR, and SBR timing and requirements.