Susan Piha, manager of research and education for the Illinois
Workers' Compensation Commission, asked CDS to share the following
news release with members.
The commission has an exhaustive FAQ that
should help answer questions. For more information on the fee
schedule, follow the links on the
commission's home page. Otherwise, call the commission at (312)
814-6611 for more information.
By law, all medical treatment provided to a workers'
compensation claimant on or after February 1, 2006 is subject to a
fee schedule. A provider is still free to contract with payors for
different payment terms but, in the absence of a contract, the
provider will be paid according to fee schedule.
By law, a fee for each procedure was calculated for each
three-digit zip code in Illinois....
When the IWCC lacked sufficient data to calculate a fee, the law
provides that such bills shall be paid at 76% of the charged
amount. Dental services that are billed with ADA codes, for
example, are paid at 76%. Services that are billed with CPT or
HCPCS codes may have fees. Refer to the online fee schedule.
The fee schedule amount is considered full payment. Providers may
not seek to obtain the difference between the charged amount and
the fee schedule amount from the injured worker or the employer.
Balance billing for workers' compensation claims is now illegal
pursuant to 820 ILCS 305/8.2(e).
The law also provides that the payor shall pay the medical provider
within 60 days of the date the payor receives a bill that contains
substantially all the required data elements necessary to
adjudicate the bill. The provider may charge interest of 1% per
month. If you cannot resolve disputes regarding payment with the
payor, you should ask the patient/injured worker to request a
hearing before an IWCC arbitrator regarding unpaid medical
The Illinois Workers' Compensation Commission operates the court
system that resolves disputes regarding workers' compensation. It
does not pay the benefits. In most cases, insurance companies pay
benefits on the employers' behalf.
state of illinois