> ## Documentation Index
> Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Workers' compensation

> Workers' comp profile: state fee schedules, e-billing mandates, authorization, and why it behaves nothing like health insurance.

**Workers' compensation** is not health insurance. It is a **state-mandated, state-regulated** system covering work-related injuries, paid by the employer's WC carrier or by a self-insured employer, under **statutory fee schedules** rather than negotiated contracts.

**Payer content ages fastest of anything on this site.** Portals move, forms change, payer IDs get reassigned, and **timely filing limits are contract-specific regardless of what any table says**. Treat this page as orientation; the payer's own current documentation and **your executed contract** are authoritative. **Checked August 2026.**

## How it differs from health insurance

|                        | Health insurance               | Workers' compensation                                 |
| ---------------------- | ------------------------------ | ----------------------------------------------------- |
| **Governed by**        | State insurance law or ERISA   | **State workers' comp statute**                       |
| **Rates**              | Negotiated contract            | **Statutory fee schedule** in most states             |
| **Network**            | Contracted network             | Varies — some states allow employer-directed networks |
| **Patient cost-share** | Deductible, copay, coinsurance | **None** — no patient responsibility                  |
| **Authorization**      | Payer prior auth               | **Carrier or employer authorization**, often strict   |
| **Claim form**         | 837P / CMS-1500                | 837P, plus **state-specific forms and reports**       |
| **Appeals**            | Payer process                  | **State workers' comp board or commission**           |
| **Timely filing**      | Contract                       | **State statute**                                     |

## The critical operational differences

**1. Verify the claim is accepted before treating.** A workers' comp claim can be denied by the carrier — meaning the injury is not compensable. Care delivered on a denied claim may leave you unpaid, and billing the patient is complicated by state rules.

**2. Authorization requirements are frequently strict**, and vary by state and by treatment type. Many states require pre-authorization for specified services.

**3. State-specific reporting is mandatory.** Most states require injury reports, treatment plans, and work-status reports on prescribed forms and timelines. **Non-submission can delay or prevent payment.**

**4. E-billing is mandated in a growing number of states**, with prescribed formats and companion requirements. Confirm your state's requirement and whether your clearinghouse supports it.

## Fee schedules

Most states set a workers' comp fee schedule by statute or regulation. It is frequently **more generous than commercial rates** for the same services — which is why WC volume can be attractive despite the administrative burden.

A minority of states use a different mechanism (usual and customary, or negotiated). Confirm your state's approach.

## Enrollment

There is generally no network credentialing in the commercial sense. What you need is:

* Registration with the state workers' comp system where required
* Any carrier or network arrangement your state's model uses
* E-billing setup where mandated

## Getting paid

<Steps>
  <Step title="Confirm the claim number and carrier before the visit" />

  <Step title="Verify the claim is accepted and the injury is compensable" />

  <Step title="Obtain authorization for the planned treatment" />

  <Step title="Deliver care and complete state-required reporting on time" />

  <Step title="Bill per the state fee schedule, with required documentation attached" />

  <Step title="Appeal through the state board process if denied" />
</Steps>

## Quirks worth knowing

* **No patient responsibility** — do not bill the patient
* **Attorneys are frequently involved**, and records requests are common
* **Independent medical examinations** may be ordered and can affect payment
* **Payment can be slow**, and AR aging expectations differ from commercial
* **Paper checks are common** — see [Handle paper checks](/guides/banking/deposit-paper-checks)


## Related topics

- [The US payer landscape](/concepts/payments/the-payer-landscape.md)
- [Payers vs insurance companies (they're not synonyms)](/concepts/payments/payers-vs-insurance-companies.md)
- [Enroll and contract with commercial payers](/guides/enrollment/enroll-with-commercial-payers.md)
- [Set up EDI, ERA, and EFT with each payer](/guides/enrollment/set-up-edi-era-eft.md)
- [File appeals](/guides/billing/file-appeals.md)
- [How to use the payer reference](/reference/payers/overview.md)
- [Payer enrollment & submission links](/reference/payers/enrollment-links.md)
- [Timely filing limits by payer](/reference/payers/timely-filing-limits.md)