Workers’ Compensation Payment Integrity

Pay the right amount.
Prove why.

BillSentry delivers pre-payment integrity built specifically for workers’ compensation. Validate medical bills against jurisdiction-specific fee schedules, coding rules and reimbursement methodologies across all 50 states plus OWCP, before payment is issued. And with RuleTrace™, every pricing decision includes the calculation, rule and regulatory source behind the allowance.

See Payment Integrity in Action →
50 States + OWCP API-First RuleTrace™ Included Source-Backed Decisions

Payment Integrity Built for Workers’ Compensation

Payment integrity sounds simple: make sure the right amount gets paid.

Workers’ compensation makes that difficult.

Reimbursement can vary by jurisdiction, provider type, place of service, procedure, modifier and date of service. States use different fee schedules, reimbursement methodologies, coding rules and regulatory requirements.

BillSentry brings that complexity into a single payment integrity engine.

Every bill is evaluated against the rules that apply to that specific claim and date of service, helping determine the correct reimbursement before payment.

Fee Schedule Accuracy

Apply jurisdiction-specific fee schedules and reimbursement methodologies across all 50 states plus OWCP.

Coding Integrity

Evaluate procedure codes, modifiers, bundling rules and other coding requirements that can affect reimbursement.

Pre-Payment Validation

Identify pricing and reimbursement issues before payment is issued, rather than trying to recover incorrect payments later.

Defensible Decisions

Every pricing decision can be traced back to the calculation, reimbursement logic and underlying regulatory source.

Providers Have RCM.
Payers Need Payment Integrity.

Healthcare providers increasingly use Revenue Cycle Management technology to make sure services are coded correctly and they receive the reimbursement they are entitled to.

Payers have the corresponding responsibility to independently validate that reimbursement.

Revenue Cycle Management asks:

“How much should we collect?”

Payment Integrity asks:

“How much should we pay?”

These shouldn’t be competing objectives.

Both sides should ultimately arrive at the same answer:

The correct reimbursement.

For workers’ compensation payers, reaching that answer requires reimbursement intelligence that understands the rules of the jurisdiction in which the claim occurred.

Learn more: Workers’ Compensation RCM vs. Payment Integrity →

Payment Integrity You Can Actually See

A payment integrity system shouldn’t simply return an allowance.

It should be able to explain it.

BillSentry’s RuleTrace™ connects the final reimbursement decision to:

  • The pricing calculation
  • The reimbursement methodology
  • The rule that was applied
  • The applicable regulatory language
  • The official source supporting that rule

“The system says the allowance is $640.”

becomes

“The allowance is $640. Here’s exactly how and why it was calculated.”

Don’t take our word for it. Inspect a real pricing decision yourself.

Open a Live RuleTrace →
Sample RuleTrace™ report showing line-by-line pricing, rules, and calculations
See a live RuleTrace™ →

Stop Payment Errors Before They Become Recoveries

Payment integrity can happen before or after payment.

Post-payment programs identify potential errors after the money has already been sent. That can mean additional investigation, provider communication and recovery efforts.

BillSentry is designed to bring payment integrity directly into the bill review workflow.

Post-Payment

Bill Paid
↓
Potential Error Identified
↓
Investigation
↓
Provider Contact
↓
Recovery Attempt

BillSentry Pre-Payment Integrity

Bill Received
↓
Reimbursement Validated
↓
Applicable Rules Applied
↓
RuleTrace™ Generated
↓
Correct Payment Issued

The goal is simple: identify reimbursement issues before they become payment recovery problems.

More Than a Fee Schedule Lookup

Accurate workers’ compensation reimbursement requires more than finding a price in a fee schedule.

The correct allowance may depend on the interaction between multiple rules and reimbursement methodologies.

BillSentry’s payment integrity engine can evaluate factors including:

Coding & Services

CPT/HCPCS Modifiers Bundling Multiple Procedures

Provider & Facility

Provider Type Facility Type Place of Service Facility Reimbursement

Pricing Methodologies

Fee Schedules Medicare-Based Pricing UCR

Jurisdictional Rules

State-Specific Policies Federal Workers’ Compensation Requirements

The result is not simply a price. It’s a reimbursement decision based on the rules applicable to that bill.

Add Payment Integrity Without Replacing Your Platform

You don’t need another claims system.

BillSentry provides the reimbursement intelligence underneath the systems you already use.

Carriers, TPAs, RCM platforms, and other technology partners can integrate BillSentry directly into existing claims, medical billing, bill review, or payment workflows through a single API.

Your Existing Platform

Claims · Bills · Workflow · Payments

↓

BillSentry Payment Integrity API

Fee Schedules · Coding Rules · Reimbursement Logic · Regulatory Rules

↓

Pricing Decision

Allowance · Reason Codes · RuleTrace™ · Regulatory Sources

JSON in. Defensible reimbursement out.

Your platform remains the system your users work in. BillSentry provides the workers’ compensation reimbursement infrastructure behind it.

Payment Integrity Across the Workers’ Comp Revenue Cycle

Payers & TPAs Prevent incorrect payments before they happen. Independently validate medical bills and support reimbursement decisions with transparent, source-backed pricing logic. Payment Integrity for Payers → RCM & Medical Billing Know what every workers’ comp bill should pay. Validate expected reimbursement before submission, identify potential underpayments after adjudication, and give recovery teams the pricing logic behind every opportunity. BillSentry for RCM → Providers Understand how reimbursement was calculated. Verify allowances, investigate potential underpayments and see the rules and calculations behind reimbursement decisions. BillSentry for Providers → Technology Partners Add payment integrity without building it yourself. Embed workers’ compensation reimbursement intelligence into your existing claims, RCM, or bill review platform through a single API. Explore the BillSentry API →

Pay the Right Amount. Prove Why.

Modern payment integrity should do more than produce a number. It should determine the correct reimbursement, apply the appropriate jurisdiction-specific rules, and provide a transparent record of how the decision was reached.

That’s what BillSentry was built to do.

See the math, rules and regulatory sources behind a real workers’ compensation pricing decision.

View Live RuleTrace