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Occupational Health Billing Services
Qualigenix provides occupational health billing services for occupational medicine clinics and employer programs: routing each visit to the right payer, pricing workers' compensation bills against state fee schedules, invoicing employers, and following up on every open claim, delivered remotely to clinics in 48 states. Your clinic bills workers’ comp carriers, employers and health plans, and each one pays by different rules. Qualigenix routes every visit to the right payer at check-in, prices comp bills to your state’s fee schedule, and invoices employers at contract rates.
Quick Answer: What Occupational Health Billing Involves
Occupational health billing means sending each visit to the payer responsible for it: a workers' compensation carrier for a work injury, the employer for a pre-placement physical or drug screen, or the patient's health plan for unrelated care. Each payer uses different forms, fee schedules and documentation. Qualigenix routes every visit correctly at check-in and follows each claim to payment. Book a free billing audit: 786-259-0231.
01
Payer Routing
A single clinic sees work injuries, employer-paid exams and personal care on the same day. A work injury billed to the patient's health plan gets denied, and an employer service billed as a claim never gets paid at all.
02
Adjuster Approvals
Comp carriers often require adjuster approval before imaging, specialist referrals, therapy or extended treatment. Care delivered ahead of approval is frequently denied or reduced.
03
State Fee Schedules
Each state sets its own workers' compensation fee schedule, billing forms and filing deadlines. Bills priced against the wrong schedule are cut on bill review, and the reduction often goes unchallenged.
04
Employer Invoicing
Pre-placement physicals, drug screens and surveillance exams are billed to the employer at contract rates, not to insurance. Without contract-level pricing and monthly invoicing, these services slip through as unbilled work.
05
Claim and Employer Verification
A comp bill needs the claim number, date of injury, employer and carrier on file. A missing or wrong claim number is one of the most common reasons comp bills are rejected.
06
Causation and Work-Status Records
Comp carriers pay based on documented causation, work restrictions and return-to-work status. State-specific first-report forms, such as California's Doctor's First Report of Occupational Injury or Illness (Form 5021), must be filed on time.
07
Workers' Comp Denials
Comp denials usually come from disputed compensability, a missing claim number or a fee-schedule reduction. Each needs a different response, and many go unworked because the clinic doesn't have someone who knows comp billing.
08
DOT, OSHA and Records Rules
DOT drug and alcohol testing follows 49 CFR Part 40, and DOT physicals must be performed by examiners listed on the FMCSA National Registry. Employee medical records must be kept confidential and separate from what the employer receives.
PRECISION: WHAT QUALIGENIX DOES
What Qualigenix Does About Each Occupational Health Leak
Qualigenix stops each leak at the point it starts, so the right bill reaches the right payer the first time.
Payer Routing at Check-In
Every visit is tagged at check-in as workers' comp, employer-paid or health plan, and the right form and fee schedule follow from that tag.
Adjuster Authorization Tracking
We request adjuster approvals before treatment expands and log each approval against the claim, so services delivered match services approved.
Fee-Schedule Pricing
Comp bills are priced against the fee schedule of the state with jurisdiction over the claim, and bill-review reductions are checked against that schedule before they're accepted.
Employer Invoice Reconciliation
Employer services are billed at contract rates on a regular invoice cycle, and payments are matched to each line so short-pays and unbilled services are caught.
Claim Verification
We confirm the claim number, carrier, adjuster and date of injury before the bill goes out.
Injury Report Support
We track required state injury reports and work-status forms against each comp visit and flag any that are missing before billing.
Comp Denials and Appeals
Denials and bill-review reductions are worked by cause, with reconsideration and appeal requests sent where the record supports payment. Qualigenix overturns 79% of the denials it works.
Compliance Monitoring
We bill DOT, non-DOT and employer services under the rules that govern each, and keep employer reports limited to what the employer is entitled to see.
Claims, Posting, AR and Reporting
Claims and invoices go out with an under 24-hour average submission turnaround, payments are posted by payer type, and open comp and employer balances are worked before they age. Reports show revenue by comp, employer and health plan.
CASE STUDY 01
How An Occupational Health Clinic Recovered $61K On Payer-Routing Errors
THE SITUATION
Work-related injury visits were billed to the patient's health plan instead of workers' compensation, and DOT physicals were billed as covered medical visits, so claims denied and state fee-schedule rates were missed.
WHAT QUALIGENIX DID
We routed injury claims to workers' comp at state fee-schedule rates, billed employer-direct services correctly, and separated non-covered exams.
Key Outcomes & Turnaround
24% to 2%Auth Denials
$76000Revenue Recovered
77% to 95%Clean Claim Rate
Audited Practice Results
How An Urgent Care and Occupational Program Recovered $176K On Employer-Billing Backlog
THE SITUATION
Employer-direct and workers' comp claims aged after a billing gap, with injury and screening charges unbilled across accounts.
WHAT QUALIGENIX DID
We cleared the backlog, reconciled employer-direct billing, and set a submission cadence by payer type.
Key Outcomes & Turnaround
24% to 2%Auth Denials
$76000Revenue Recovered
Comp Auth TrackingWorkflow Fix
Audited Practice Results
How An Employer On-Site Clinic Recovered $76K On Specialist & Testing Authorization
THE SITUATION
Advanced testing and specialist referrals in workers' comp proceeded without authorization, driving denials and disputes.
WHAT QUALIGENIX DID
We added authorization tracking for comp testing and referrals and documented causality and medical necessity.
Key Outcomes & Turnaround
35 to 10AR Over 90 Days
$76000Revenue Recovered
Payer-Type SplitProcess Fix
Audited Practice Results
Occupational Health Coding by Service Line
Work Injury Visits (99202–99215)
Initial and follow-up work injury visits are coded as new or established office visits and billed to the comp carrier with the claim number and work status.
COMPLIANCE
How We Keep Occupational Health Billing Compliant
Qualigenix bills occupational health services under the rules that apply to each payer: state workers' compensation fee schedules and filing requirements, 49 CFR Part 40 for DOT drug and alcohol testing, and HIPAA's allowance for disclosures required by workers' compensation law (45 CFR 164.512(l)). Employer reports carry work status and restrictions, while the full medical record stays with the clinic. All work is HIPAA-compliant.
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Audit Pass Rate
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Variance Threshold
Why Occupational Health Clinics Choose Qualigenix
Occupational health clinics choose Qualigenix because it handles comp carriers, employer accounts and health plans under one team, with each payer billed by its own rules. Precision at check-in produces measured Progress at collection. Qualigenix results across all specialties it bills:
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Net collections rate
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First-pass clean claim rate on first submission
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Denials overturned on appeal
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States served
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Average onboarding time
QUESTIONS BUYERS ASK
Frequently Asked Questions
Qualigenix prices occupational health billing after reviewing your visit mix across comp, employer and health plan work. A free billing audit gives you a quote and shows where revenue is leaking now. Call 786-259-0231 to start.
We price each comp bill against the fee schedule of the state with jurisdiction over the claim and check bill-review reductions against that schedule. Reductions that don't match the schedule are disputed.
Employer reports carry only work status, restrictions and the results the employer is entitled to. The full medical record stays with the clinic, and disclosures to comp carriers follow what state workers' compensation law requires.
Yes. Qualigenix works open comp claims by carrier and age, corrects claim data, and disputes or appeals where the record supports payment. Most clinics start with a free AR review.
Yes. Qualigenix tags every visit at check-in by the payer responsible and bills it with that payer's form, fee schedule and documentation.
Yes. Qualigenix invoices employers at their contract rates for DOT physicals, drug screens and surveillance exams, then matches payments to each invoice line.
Qualigenix works in 133 EMR and EHR platforms and bills from the system your clinic already uses. We confirm access and workflow during onboarding.
Qualigenix onboards new clinics in 6 days on average. Call 786-259-0231 to set a start date.