Employers who choose to participate in the $15K Program pay up to $15,000
in medical and pharmacy bills. They inherently approve the treatment in the
normal course of the injury. They cannot authorize or deny treatment, or
additional conditions. That means they cannot process a Physician's Request
for Medical Service or Recommendation for Additional Conditions for Industrial
Injury or Occupational Disease (C-9). In addition, their managed care organizations (MCOs)
cannot authorize treatment or pay medical bills.
If you want to enroll in the $15K Program, call 1-800-644-6292 and listen to the options.
Once you enroll, you are responsible for the bills in all medical-only claims
(claims with seven or fewer lost days from work) with injury dates after the
enrollment effective date.
*You must maintain these records for six years from the last date of bill payment.
Notify your injured workers and their health-care providers that you,
not the MCO, are paying the medical bills for an injury
Pay all bills within 30 days of receipt or risk disqualification from
For claims with dates of injury before July 1, 2009, pay as billed
or in accordance with the pre-negotiated payment agreement with providers
For claims with dates of injury after July 1, 2009, pay in accordance
with BWC's fee schedule.
Note: BWC’s professional (practitioner)
fee schedule is available in the Medical Providers section under Look-ups.
Facility reimbursement policies are in Chapter 3 of the
Provider Billing and Reimbursement Manual in the Medical Providers section under Services.
Notify BWC and the MCO if/when the $15,000 maximum is reached and supply
proof of such payment to the MCO
Report some claims to Medicare beginning July 2010. You can learn more about this
Centers for Medicare and Medicaid Services Web site.
REMINDER: This is a federal requirement.
Keep a record* of all work-related injuries, including:
Injured workers name, address and Social Security number;
Date and time of injury;
Type of injury;
Part of the body injured;
A brief description of the accident that led to the injury;
Copies of all bills with proof and date of payment under
- Proof of payments made within 30 days of request from BWC;
- Documentation for excluding any wages paid to the employee
while off work in the $15,000 limit;
- Documentation showing no denial of any bills. If you participate
in the program, you inherently approve the first $15,000 of medical and
EXCEPTIONS to program requirements
You notify us within 14 days of learning that a claim
has been filed that you do not want to pay for the bills
in that claim.
You notify us that you've reached the $15,000 maximum
in a claim.
You notify us that you do not want to pay for any additional medical
bills, and you provide the last date you will be responsible for a
Note: The last date can be the date of injury or after a payment
of any amount up to $15,000.
Once you tell us to remove a claim from the $15K Program your MCO will
begin processing the bills in that claim regardless of the date of service on a bill.
Reaching the $15,000 maximum
If the payment of a particular bill will exceed the $15,000 maximum, pay that portion
of the bill that brings the total paid to $15,000, and then tell the provider to
bill the MCO for the balance. Remember, you must notify BWC and the MCO that
you've reached the $15,000 maximum. Also, send copies of all bills with proof of the
dates of payment to the MCO. At that point, it becomes the MCO’s responsibility to process
all future bills received. We will not reimburse you for any bills you've paid.
If the injured worker loses more than seven days of work, the injury is no longer
eligible for this program. The process to change the claim to lost time will
automatically remove the claim from the $15K Program. The MCO will be responsible
for processing subsequent medical bills. We do not reimburse you for bills paid
under this program prior to the change over from medical only to lost time.
Injured worker and employer rights
- Payment of medical bills under this program in no way supersedes the right
of the injured worker to file a workers compensation claim.
- Payment of medical bills under this program does not waive BWCs right to
hear and decide a claim if filed.
- Payment of medical bills under this program does not waive the employers
right to contest a claim if filed.
Opting out of the program
You can opt out of the $15K Program by calling 1-800-644-6292 and listening to the options.
Once you notify us that you want to opt out, we will send written confirmation of this
decision. The MCO will then be responsible for processing bills received after
the program termination date for all medical-only claims. To opt a specific claim out of the program,
you must notify the BWC-assigned claims service specialist for that claim.
We will not mediate disputes between you and any medical provider(s) pertaining
to bill payment. If you fail to meet any of the requirements for this program,
including responding timely to bill payment requests, no denial of treatment
and maintaining active workers' compensation coverage, you are subject to