Because lien settlements often encompass multiple medical bills, Submitters are encouraged to report whatever line detail is available on a lien settlement transaction. Valid values for the six key fields (Carrier Code, Policy Number ID, Policy Effective Date, Claim Number ID, Bill ID Number and Line ID Number) must be reported on all submitted records to avoid the record being rejected and returned to the Submitter. Additionally, if the amount of a lien settlement covers multiple claims, the amount of the lien settlement must be allocated to individual claims.
Certain fields (e.g., Quantity, Secondary ICD-9, Paid Procedure Code Modifiers and Network Service Code) may not always be applicable in cases of lien settlements encompassing multiple bills. Failure to report these fields will result in Quality Tracking edit failures, but these edit failures will not result in record rejection. The WCIRB reviews counts of Quality Tracking edits or missing expected field values if the counts appear to be unusually high in comparison to typical norms.