Medical Providers

Welcome to our Medical Providers Support Page. Securely upload medical files for expedited invoice processing, submit a bill reconsideration, request bill status updates, and find other helpful information below.

 

Billing

All invoices must be submitted to Synergy Coverage Solutions; please do not send invoices to the employer or injured worker.

 

Medical Bill & Medical Records Upload

For expedited invoice processing, providers can securely upload and submit
medical bills using the File Upload option below. All charges must be submitted on
CMS 1500 (HCFA), UB04 Form, or accordingly on each state’s industrial commission
approved claim form. Medical bills must be submitted with medical records.

Medical bills can also be submitted by mail or fax.

FILE UPLOAD

 

Medical Bill reconsideration

Click on the link below to submit a medical bill reconsideration.

Bill Reconsiderations must include a completed Appeal Form, medical bill, original EOB, and notes associated with the visit.

Click here for the Appeal Form.

SUBMIT BILL RECONSIDERATION

 

Status of bill

To check on the status of a bill, please complete the form below. A representative will be in contact within 1-3 business days.

 

W-9 Form

Medical providers must complete a W‐9 form and submit to Synergy Coverage
Solutions to receive payment for workers’ compensation claimant invoices. Click
here to complete the W‐9 form.

Signed and completed forms can be uploaded using the link below, faxed to
(704) 927‐2867 or emailed to providerw9@synergyinsurance.net.

W-9 UPLOAD

 

Pre-Authorization Reviews

Please be aware that Synergy Coverage Solutions may conduct Pre-Authorization reviews in North Carolina, Georgia, and Illinois.

North Carolina Providers, please click here for our North Carolina UR Plan.

 

Provider Forms

Click on the links below to access medical provider forms:

 

Essential workers’ compensation Programs

The following key programs are essential to Synergy Coverage Solutions’ workers compensation claims. Our goal is to aid the injured employee to reach maximum medical improvement as quickly as possible.

 

Post-Accident drug screen

As applicable, Synergy recommends a 10 panel drug screen to test for the use of THC, cocaine, opiates, amphetamines, and phencyclidine (PCP), benzodiazepines,
methadone, oxycodones, barbiturates, and buprenorphine.

Click here to submit results.

 

Early Return to Work / Modified Light Duty

When an employee is injured on the job, our goal is to return the injured worker to productive employment, and a physician’s evaluation plays a critical role. Early Return to Work and Modified Light Duty programs can be utilized to safely return injured employees to work as soon as medically appropriate. When the physician specifies the patient’s capacities and abilities, as well as restrictions, it benefits not only the injured worker, but also their employer.

The forms available below are industry‐specific Transitional Duty Task Lists to indicate tasks that are within the current physical capacities of the employee you are treating. Completed task lists, initialed and signed, should be returned to Synergy Coverage Solutions by email or fax; please also give a copy to the injured worker to hand to their supervisor.

 

Prescription medications

Synergy Coverage Solutions utilizes Optum as our Pharmacy Benefit Manager. Coverage includes prescription medications necessary for treatment of accepted
conditions resulting from workplace injuries. Please note: Physician dispensed medications are not authorized/honored by Synergy Coverage Solutions.

Medications that are deemed inappropriate for the age of the injury or do not meet the medication parameters Synergy has in place will require authorization by the patient’s assigned Claims Adjuster at Synergy Coverage Solutions. Please call 1‐866‐710‐0908 for authorization.

Office Information

217 South Tryon Street
Charlotte, NC 28202

Monday - Friday 8:30am-5:00pm (EST)


Main 704-927-2860

Toll Free 866-710-0908

Fax 704-927-2867