QUEST Integration – Workers’ Compensation

Original Effective Date:

04/01/1999

Current Effective Date:

01/01/2015

Claims for services related to a work-related illness or injury must be submitted to the employer’s workers’ compensation carrier when applicable. Members who report work-related injuries to their Med-QUEST Caseworker and are covered by a workers’ compensation plan for the injury are identified by the TPL “Workers’ Compensation”. You can view active/applicable TPLs on HHIN. Regardless of whether this coverage is reflected on the member’s file, claims for work-related injuries must be submitted to the workers’ compensation carrier when appropriate. Additionally, as a general reminder, patients should always be advised to report work-related illnesses or injuries to their Med-QUEST Caseworker.

Workers’ Compensation Denials

If the workers’ compensation carrier denies payment, attach a copy of the denial letter to your claim.

Note: If HMSA’s Plan for QUEST Integration Members pays for services that should have been billed to a workers’ compensation carrier, HMSA will recoup payment from the provider.

All claims are subject to patient eligibility at the time of service, HMSA’s payment criteria guidelines, and the provisions and limitations of the QUEST Integration plan.

Revision History