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Setting Up a Workers' Compensation Case / Policy

This guide provides step-by-step instructions to create a Workers' Compensation (Workman's Comp) case and configure the associated policy in ChiroHD.

This guide provides step-by-step instructions to create a Workers' Compensation (Workman's Comp) case and configure the associated policy in ChiroHD.


Step 1: Create the Workers' Comp Case

  1. Access the Patient Profile.
    ​Search for the patient using the search bar.
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    OR click on their name on the calendar.

  2. Click on the Cases tab, and click Create New Case.

  3. Choose from the dropdown menu, Workers' Comp.
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  4. Choose Billing Method:

    • It is common practice to select Billing Suspended for Workers' Comp cases.

    • Reason: Many insurance companies or attorneys prefer to receive billing documents (such as statements and SOAP notes) only after the case is fully resolved, rather than receiving bills weekly.
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  5. Click Submit.


    (Optional) Set the case as the Default Case if it is the active treatment case for the patient.


Step 2: Add Diagnosis Codes (DX Codes)

  1. Open the Insurance Case < Treatment / DX Tab
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  2. Add Diagnosis Codes by clicking in the Add code to case.
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  3. Choose the Start Date (It will default to today’s date).
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  4. Save Changes.
    ​
    ​Tip: If you backdate the first DX code, subsequent codes will use the same start date automatically.


Step 3: Set Up the Policy Information

  1. Navigate to your Insurance / Coverage tab. Click Add New Insurance / Coverage.
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  2. Complete Policy Information:
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    • Insurance Company/Attorney and Nickname: Select the appropriate third-party payer (must be pre-created).
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    • Priority: Choose primary or secondary coverage. If there is only one coverage entity, then select Primary
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    • Coverage Start Date and End Date: Input the start date from the Workers' Comp case documents. The end date can be left blank if unknown.
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    • ID/Claim Number: Enter the claim number provided by the insurance or employer.
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    • Group Identifier: N/A
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    • Plan Identifier or Prior Authorization Number: Optional.
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    • Notes: Optional, for any internal notes.
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    • Relationship to Insured: Choose Self
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    • Claims Related To: Set to Work (for a work-related injury).
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    • State of Incident (if applicable): Indicate the state where the accident occurred.
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    • Maximum Coverage: If available, enter the maximum covered amount for medical claims.
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    • Date of Current Illness or Injury: Input the date the work-related injury occurred.
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    • Onset Qualifier: Select Accident
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    • Additional Optional Details:

      • Box 19: if necessary for additional notes.

      • Billing Provider Other ID: Box 33b (optional)

      • Accept Assignment will default to "Yes" but this is where the office would say whether they are accepting assignment from the third party payer or not.

      • Referring Provider: typically not required for Workers' Comp cases.
        ​

    • Check for Missing Patient Information:

      • A red warning will appear if key patient information (e.g., gender, birthdate) is missing.

      • Click Edit next to the patient's information and complete the missing fields.
        ​

    • Click Save.


Step 4: Configure Default Services (Optional)

  • Under Default Services tab, select services that will automatically populate on each SOAP note for this case.

  • Click Save Changes.
    ​

    For more information and detailed instructions and step-by-step guidance please refer to our other resources on Default Services.


Step 5: Manage Billing and Settings

  • Navigate to your Workers Comp Case < Settings Tab.
    ​

  • Suspend Billing: Used primarily for PI (Personal Injury) cases where billing should be delayed until settlement.

  • Edit Case Name: Adjust the Case Name if desired (e.g., “Insurance 2024").

  • Change Case Type.

  • Set Default Calendar Provider and Default Billing Provider for this case.

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