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Bill Reimbursement Process

When SMAI receives a bill, we provide clinical editing reviews before submitting it to the BWC. Once the bill is approved by the BWC, we will process it and mail a check to the billing provider. The table below shows the expected timeframe:

Days Activity

1 - 7

SMAI enters the bill and ensures the bill is valid. If the bill is not valid, a letter is sent back explaining why. If the bill is valid, then SMAI clinically edits and reprices the bill and submits it to the BWC

8 - 15

BWC reviews the bill and transfers the funds to SMAI.

16 - 22

SMAI prints and mails the check.

Common Reason why Payment is Delayed

  • Needed medical documentation is not submitted with the bill
  • The claim or billed ICD9 is not in a payable status
  • Billing provider is not BWC certified
  • Missing required data items
  • NPI # provided not registered with BWC and no WCID # provided
  • No prior authorization for treatment or prior authorization has expired

Spooner Medical Administrators, Inc. | 28301 Ranney Parkway | Westlake, Oh 44145 | Main: 440.899.2400 | Toll-Free: 800.542.9479 | Fax: 440.899.2411