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Accident & injury claims
An accident case rarely clears through a single insurer. We bill the right payer in the right order, document the injury the way adjusters and attorneys expect, and stay on the account until the lien is resolved.
Why it's different
A routine office visit goes to one health plan and is usually settled within a few weeks. A car accident or a fall can put four different coverages in play on the same patient, and the one that ultimately pays might not respond until a lawsuit closes a year or more later.
That timeline changes what billing actually involves. Liens have to be recorded and tracked. Subrogation claims from health plans and Medicaid have to be watched for. A case can sit open for months without being wrong, denied, or forgotten. Treating that as normal, rather than an exception to fix, is what separates PI billing from everyday claims.
The account isn't stalled. It's waiting on a settlement, and someone has to know the difference.
Payer types
Before a claim goes out, we confirm which of these applies, and in what order.
Required in a number of states. Pays medical costs up to a set limit without regard to who caused the accident, and is typically the first coverage billed.
Available in both no-fault and at-fault states. Limits are usually smaller than PIP, and the coverage may respond alongside it or only after it.
Applies when the at-fault driver carries too little insurance or none at all. A claim against it moves differently than a standard liability claim and can involve arbitration.
The responsible driver's insurer, which often pays only after the injury claim or lawsuit resolves. This is usually what stretches the account's timeline.
How we work the account
Miss a step here and the ones after it inherit the problem.
Capture the date of loss, claim numbers, adjuster contact, attorney representation, and any letter of protection before the first claim goes out.
Pair each service with the injury code, the correct encounter character, and the external cause code the payer is expecting.
Route claims to whichever payer is responsible first, whether that's no-fault coverage, MedPay, or a health plan.
Work denials, respond to requests for records or an independent medical exam, and keep the account moving instead of letting it age untouched.
Reconcile the balance against the settlement or verdict, negotiate a reduction where it makes sense, and record final payment.
Skip the setup step and a case can go untracked for months before anyone notices.
Failure points
Most of the revenue lost on PI accounts traces back to a short list of avoidable gaps.
Coding and Documentation
Accident coding carries more weight than a routine encounter. The note may later be read by an adjuster, a defense attorney, or a judge, so the diagnosis has to hold up outside the exam room.
Two parts of ICD-10-CM cover most of this work. The injury chapter (S00–T88) documents the condition itself, from strains and fractures to disc injuries and concussion. The external cause chapter (V00–Y99) documents how the injury happened. Most codes in the injury chapter also need a seventh character marking whether the visit is an initial encounter, a subsequent one, or care for a lingering effect of the injury.
Because PI treatment often runs for months, the documentation has to keep tying each visit back to the original mechanism of injury, not just the diagnosis on file. That link is what supports medical necessity for an extended course of physical therapy, chiropractic care, or pain management.
Examples only. Current CPT and ICD-10-CM guidelines, along with the documentation on file, determine the codes used on any given claim.
Before the first claim
Accurate intake heads off most of the denials that would otherwise show up weeks later.
Revenue cycle
PI receivables don't behave like a 30 or 60 day balance, so the workflow is built around accounts that stay open for months and payers that change mid-case.
Accident accounts are reported apart from routine receivables, so a claim waiting on a settlement isn't mistaken for one that's simply overdue.
Why A2Z Billings
These are the parts of PI billing that tend to break when a practice tries to run them alongside its everyday claims.
PIP, MedPay, UM/UIM, and liability billed in the sequence each case actually calls for.
Injury and external cause codes, encounter characters, and modifiers applied so claims aren't rejected on technical grounds.
Letters of protection, ERISA plans, and Medicaid liens followed from the first visit through settlement.
Accident accounts kept apart from standard receivables for a clear read on what's actually outstanding.
Itemized statements and records prepared for demand packages, with regular updates on where each case stands.
Support for practices, groups, clinics, and hospitals across the United States, with attention to state-specific requirements.
This sits within the wider work we handle: revenue cycle management, medical coding, denial management, accounts receivable recovery, payment posting, eligibility verification, credentialing, and prior authorization.
Questions
Both pay regardless of fault, but PIP is required in no-fault states and typically has a higher limit, while medical payments coverage is optional and usually caps out lower. Depending on the state and the policy, they can apply together or one after the other.
A UM or UIM claim isn't against the at-fault driver's insurer, since that driver has none or not enough. It's a claim against the patient's own policy, and it can involve arbitration rather than a straightforward liability negotiation, which usually means a longer timeline before it resolves.
Health plans that paid for accident-related treatment generally have a right to be reimbursed from the settlement before the patient or provider sees the remaining funds. We flag these liens early so they're addressed at settlement instead of surfacing as a surprise deduction.
Often, yes, particularly when the settlement doesn't fully cover every outstanding bill. We work with the attorney's office to reach a reduction that still reflects the value of the care provided.
An itemized statement, a chronological treatment summary, and documentation tying each visit back to the accident. Law firms use this to value the claim, so incomplete or unclear records can slow the whole case down.
No. Claim filing deadlines run on the payer's timeline, not the litigation's. A case can be waiting on a settlement for a long time while a filing deadline with an insurer is approaching regardless, which is one of the more common ways revenue gets lost.
Once the PIP limit is reached, further claims to that policy are denied. Coverage typically shifts to MedPay, the patient's health insurance, or the liability claim, and we monitor the remaining balance so that handoff happens before claims start bouncing back.
If liens, no-fault claims, and pending settlements are tying up your receivables, we can look at your current process and point to where revenue is being delayed or lost, from intake through the final payment.
Serving healthcare providers across the United States
