Workers' Compensation Billing Services That Get Nevada Providers Paid in Full
You treated the injured worker. Now the insurer, the TPA, and the adjuster all stand between your practice and the payment. Our workers' comp medical billing team works every claim to Nevada's rules: the C-4 filed on time, every service coded to the Nevada Medical Fee Schedule, and every reduction challenged before the appeal window closes.
Since 2014
Billing Nevada practices
Fee Schedule
Nevada Medical Fee Schedule specialists
4–5%
of net collections
No setup fee
60-day exit
What Is Workers' Comp Medical Billing,
and Why Do Clean Bills Still Stall?
Workers' compensation medical billing is the process of billing a workers' comp insurer, self-insured employer, or third-party administrator (TPA) for care given to an employee injured on the job. In Nevada, payment is set by the state's Medical Fee Schedule, not by a negotiated contract, and every bill must tie to an open, accepted claim with the right reports attached.
Get any of those pieces wrong and the bill stalls. Get all of them right, and workers' comp becomes one of the most dependable payers in your mix.
Why Workers' Comp Can't Be
Billed Like Health Insurance
| Health insurance billing | Workers' compensation billing | |
|---|---|---|
| Who pays | The patient's health plan | The employer's workers' comp insurer, self-insured employer, or TPA |
| What's verified | Eligibility and benefits | Claim number, claim acceptance, employer, adjuster, and authorized treatment |
| How payment is set | Contracted rates or plan allowed amounts | The Nevada Medical Fee Schedule |
| Patient cost share | Copays, coinsurance, deductibles | None on an accepted claim; the injured worker isn't billed for covered care |
| Paperwork | Claim form | Claim form plus the C-4, progress reports (D-39), and treatment notes |
| Disputes | Payer appeals | Insurer reconsideration, then a billing appeal to the Nevada DIR |
| Case milestones | None | IME, maximum medical improvement (MMI), permanent partial disability (PPD) rating, claim closure |
Find out what your workers' comp claims are really owed.
Six Ways Nevada Practices Lose Workers' Comp Revenue,
and How We Stop Each One
A late or incomplete C-4.
Nevada expects it within 3 working days of treatment. Without it, the claim may never open.
Billing before the claim is accepted.
Insurers have 30 days to accept or deny. Bills sent into that gap, without tracking, are often lost.
Reports that don't travel with the bill.
Without progress notes and a current D-39, payment waits.
Fee schedule reductions accepted without question.
Modifier and bundling errors cut payments, and nobody checks the EOB.
Missed appeal windows.
A billing dispute has to reach the DIR within 60 days of the EOB.
Adjusters who never call back.
Claims without structured follow-up simply age.
Nevada's Workers' Comp Rules,
Mastered So Your Team Doesn't Have To
Nevada's workers' comp system is governed by NRS and NAC Chapters 616 and 617: the Nevada Industrial Insurance Act and the Nevada Occupational Diseases Act. The Workers' Compensation Section of the Division of Industrial Relations (DIR) publishes the Nevada Medical Fee Schedule, investigates medical billing complaints, and decides provider billing appeals.
Every payment depends on a sequence of forms and deadlines. Miss one, and a valid bill can become uncollectible.
Every Nevada Form and Deadline That Decides Whether You Get Paid
| Form or step | Who | Deadline | Why it matters for billing |
|---|---|---|---|
| C-4: Employee's Claim for Compensation / Report of Initial Treatment | Treating provider, with the injured worker | Within 3 working days of treatment | Opens the claim; a physician must countersign it |
| C-3: Employer's Report of Industrial Injury | Employer | Within 6 working days of receiving the C-4 | Confirms the employer's account of the injury |
| Claim decision | Insurer or TPA | Within 30 days | Determines whether the bill will be paid |
| D-39: Physician's Progress Report and work status | Treating provider | At each visit where work status is set or changes | Supports ongoing treatment, and lost-time benefits |
| Medical bill | Provider | Generally within 90 days of the date of service | Late bills risk denial, unless there's good cause |
| Billing dispute | Provider | Within 60 days of the EOB/EOR, to the DIR | The only route to recover an improper reduction or denial |
| D-35: Request for PPD evaluation | Insurer, after a stable and ratable report | Rating scheduled within 30 days | Moves the claim toward closure |
Medical-only vs. lost-time claims. A claim becomes lost-time when the worker is off for 5 consecutive days, or 5 days within a 20-day period. Lost-time claims bring more reporting, closer insurer review, and more scope for disputes, so the paperwork has to be exact.
Paid to the Nevada Medical Fee Schedule, Never Below It
Nevada's Medical Fee Schedule sets the maximum payment for each service, along with its own rules for modifiers, bundling, and documentation. It's updated regularly, and insurers pay the lower of your charge or the scheduled amount. We code and price each service to the current schedule, and check every EOB against it, so reductions are caught and challenged.
Authorizations Secured Before Treatment, Not After the Denial
Many services need prior authorization from the insurer or its managed care organization, including surgery, advanced imaging, extended therapy, and referrals. Care outside Nevada has its own rules. We request authorizations before scheduling, track their expiration dates and visit limits, and hold bills that would otherwise deny.
Workers' Comp Records, Shared Only as Each Claim Requires
HIPAA permits providers to share records needed for workers' comp claims with insurers and employers, as state law requires. We send only what each claim needs, and handle every record under our HIPAA compliance program.
See HIPAA compliance →Treating an Auto Injury? Nevada Bills It Differently
Nevada is an at-fault auto insurance state, not a no-fault state, so auto-accident care is billed to auto medical payments coverage, liability insurers, health plans, or attorney liens. That calls for a different workflow. If an employee is injured while driving for work, the claim goes through workers' comp first.
Workers' Compensation Billing Services
That Cover Every Step to Payment
We run workers' comp as its own revenue cycle, separate from your health insurance billing, because it plays by different rules from the first visit.
Claim intake and verification
At the first visit, we capture the claim number, date of injury, employer, insurer or TPA, and adjuster. We confirm claim status before any bill goes out: accepted, denied, or under investigation.
C-4 and form compliance
We make sure the C-4 is completed, countersigned, and filed within 3 working days. We also track D-39 progress reports and work-status updates at every visit that needs one.
Authorization management
We request prior authorizations for surgery, imaging, therapy, and referrals, then track approved visits and expiration dates so treatment never outruns its approval.
Coding to the Nevada Medical Fee Schedule
Certified coders assign CPT, HCPCS, and ICD-10-CM codes with Nevada's modifier and bundling rules, and price every line to the current schedule.
Bill submission with supporting reports
We submit professional bills on the CMS-1500 and facility bills on the UB-04, with the treatment notes and reports each insurer requires, well inside the 90-day billing window.
Adjuster and TPA follow-up
Every open bill gets scheduled, documented follow-up, with escalation to supervisors when an adjuster goes silent.
EOB review and underpayment recovery
We check every explanation of benefits or review against the fee schedule, and challenge incorrect reductions, bundling, and unpaid lines.
Denials and DIR billing appeals
We request reconsideration from the insurer first. If that fails, we file the billing appeal with the DIR within 60 days of the EOB, with the records that support it.
Denied and disputed claims
When compensability is denied, we hold bills, track the injured worker's appeal, and, where Nevada rules allow, bill the patient's health plan with the denial on file, so the balance isn't stranded.
Case milestones
We track IMEs, MMI determinations, PPD ratings, and return-to-work dates, and adjust billing as the claim moves toward closure.
Multi-provider coordination
When physicians, therapists, and imaging centers treat the same injury, we keep every bill under the right claim number and prevent duplicates.
Payment posting and reporting
We post every payment, reconcile it against the fee schedule, track late-payment interest where it applies, and report collections, denial trends, and aging by insurer each month.
From First Visit to Final Payment:
Our 7-Step Workers' Comp Process
- 1
Open the case right.
Capture claim details at the first visit, and file the C-4 within 3 working days.
- 2
Confirm acceptance and authorization.
Verify claim status and approved treatment before billing.
- 3
Code and bill to the schedule.
Code to the Nevada Medical Fee Schedule, attach the reports, and submit within days, not weeks.
- 4
Follow up relentlessly.
Work adjusters and TPAs on a set schedule until each bill is paid.
- 5
Audit every payment.
Compare each EOB with the fee schedule, and catch reductions.
- 6
Appeal what's wrong.
Request reconsideration, then appeal to the DIR within 60 days.
- 7
Close the case cleanly.
Track MMI, ratings, and closure, so nothing is left open.
Have workers' comp bills aging past 60 days?
Built for Nevada Practices
That Treat Injured Workers
We bill workers' compensation for Nevada providers who treat injured workers, including:
- Occupational medicine and urgent care clinics. See Urgent care billing.
- Orthopedic surgeons and ambulatory surgery centers.
- Physical and occupational therapists, and chiropractors.
- Pain management and neurology practices. See Neurology billing.
- Imaging centers and laboratories.
- Primary care practices treating workplace injuries. See Primary care billing.
- Psychologists and psychiatrists treating work-related mental health claims. See Behavioral health billing.
We work with insurers, self-insured employers, and TPAs across Las Vegas, Henderson, Reno, Carson City, and the rest of Nevada.
Transparent Pricing: You Pay Only When You're Paid
Workers' compensation billing is included in our standard plans, at 4–5% of net collections, with no setup fee and a 60-day exit. Aged workers' comp AR can be recovered on contingency: you pay only on what we collect.
Commitments We Put in Writing,
Not in Fine Print
C-4s tracked to the 3-working-day deadline on every new injury.
Bills submitted within 24 hours of receiving complete documentation.
Every EOB checked against the Nevada Medical Fee Schedule.
Every reduction and denial worked within 5 business days, and DIR appeals filed well inside the 60-day window.
A named account manager who replies the same business day.
BAA signed before we see any patient data.
Workers' Compensation Billing
Questions Nevada Providers Ask Us
Can't find what you need? Our Nevada team answers every question before you commit.
They cover the full workers' comp revenue cycle: claim verification, C-4 and D-39 tracking, prior authorization, coding to the Nevada Medical Fee Schedule, bill submission with reports, adjuster follow-up, EOB review, denials, DIR billing appeals, and payment posting.
NRS 616C.136 sets deadlines for insurers to act on a complete bill, and requires interest when they pay late. The clock starts only when the bill and its required documentation are complete, which is why we send everything together.
Generally within 90 days of the date of service. A later bill may be accepted only for good cause, so we submit within days of each visit.
The C-4 is the Employee's Claim for Compensation and Report of Initial Treatment. The treating provider completes it with the injured worker and files it within 3 working days of treatment. It opens the workers' comp claim.
The D-39 is the treating physician's progress report and work-status certification. It documents whether the worker can work, with or without restrictions, and supports continued treatment and lost-time benefits.
Not for covered treatment on an accepted claim. If the claim is denied, other coverage may apply, and we follow Nevada's rules before any balance is billed to the patient.
Start with reconsideration from the insurer. If that doesn't resolve it, file a billing appeal with the DIR within 60 days of the EOB. We handle both, with the records that support your claim.
Some insurers and self-insured employers use panels or managed care organizations for treating providers. We confirm the insurer's requirements before the first visit, so you're paid for the care you give.
Yes. Therapy and chiropractic bills depend on authorized visit counts and timed-code rules under the fee schedule, and we track both.
Keep exploring
Stop Chasing Adjusters. Start Collecting What Your Care Has Earned.
Send us your open workers' comp AR. We'll show you which bills can still be paid, which reductions are worth appealing, and where your process is losing time. You get a written review within 5 business days, at no cost.
Please don't include patient information. We sign a BAA before reviewing any claim data.