SimpliClaim: Software Solutions for Your Business

As of August 1, 2025, the New York Workers’ Compensation Board (NY WCB) is requiring all healthcare providers to submit Workers’ Compensation-related medical bills electronically. This mandate is designed to streamline the claims process, reduce paperwork, and improve efficiency in medical billing for injured workers.

How Does This Affect Healthcare Providers?

Providers who are still submitting paper claims must transition to an EDI-compliant billing system before the deadline to ensure compliance. Failure to comply may result in claim processing delays or potential rejections.

How SimpliClaim Can Help

SimpliClaim provides a seamless and fully compliant EDI solution to help providers:

• Submit Workers’ Compensation claims electronically with ease.
• Ensure compliance with NY WCB requirements to avoid penalties.
• Reduce errors and rejections with AI-driven claim validation.
• Access real-time tracking to monitor claim status and payments.

Workers’ Compensation billing is complex, with strict EDI requirements, frequent claim denials, and detailed documentation needs. SimpliClaim takes the guesswork out of the process by automating claim submissions, reducing errors, and optimizing reimbursements.

Common Challenges in Workers’ Compensation Billing

• EDI complexity – Requires specific loops, segments, and payer requirements.

• Claim rejections – Due to missing or incorrect information.

• Regulatory compliance – Providers must meet NY WCB and state-specific guidelines.

• Manual inefficiencies – Paper claims slow down payments and increase errors.

How SimpliClaim Solves These Issues

• Automated EDI submissions for faster, error-free claim processing.
• AI-powered validation to detect and correct errors before submission.
• Seamless integration with EMR and practice management systems.
• Real-time claim tracking and clearinghouse support.

EDI claims for Workers’ Compensation require specific loops and segments to properly submit provider, patient, and injury details. Any missing or incorrect data can lead to claim rejections or delays.

Key EDI Loops & Segments for Workers’ Compensation

• Patient Demographics (Loop 2000A-2000C) – Ensures correct patient identification.

• Billing Provider Details (Loop 2010AA) – Verifies provider credentials and NPI.

• Claim Information (Loop 2300) – Includes injury details, diagnosis codes, and billing specifics.

• Payer Information (Loop 2330B) – Ensures claim reaches the correct payer.

How SimpliClaim Helps

• Configures all necessary EDI loops & segments to meet NY WCB standards.
• Prevents claim rejections by ensuring accurate data entry.
• Provides expert guidance on Workers’ Compensation EDI formatting.

SimpliClaim can help by streamlining and automating the medical claims submission process, making it faster, more accurate, and less costly. 

SimpliClaim simplifies and accelerates medical claims processing by reducing errors, minimizing denials, and ensuring faster reimbursements and lower administrative costs for healthcare providers.

Switching to an automated EDI billing solution is the key to faster reimbursements, fewer rejections, and a more efficient workflow.

Manual vs. Automated Billing – What’s the Difference?

With SimpliClaim, providers can:

• Save time by eliminating manual data entry.
• Improve claim accuracy with built-in compliance checks.
• Get paid faster by reducing delays caused by errors or missing information

With the NY WCB mandate approaching, providers need a reliable, compliant, and efficient EDI solution. SimpliClaim is designed to simplify Workers’ Compensation billing, ensuring seamless claim submission, compliance, and faster reimbursements.

Why SimpliClaim Stands Out:

• All-in-One EDI Solution – We handle software, submissions, and support.
• AI-Driven Error Detection – Reduce claim rejections before submission.
• Real-Time Clearinghouse Access – Monitor claims and receive updates instantly.
• Expert EDI Support – Our specialists ensure all claims meet Workers’ Compensation EDI requirements.
• Fully Compliant with NY WCB – Stay ahead of regulatory changes with automated updates.

By choosing SimpliClaim, you are investing in a smarter, faster, and error-free EDI process that helps you focus on what matters most—providing quality patient care.