Blog: Daisy News

News, data, & insights about workers' comp billing

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  • January 17, 2018

    Glitch at York Risk May Delay Bill Payment

    Technical problems at third-party administrator York Risk Services left roughly 15,000 bills unprocessed. The error was discovered and resolved by York’s in-house bill review, which is currently processing the affected bills. According to York representatives, it may take up to 30 days from their discovery of the glitch to complete the processing.

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  • January 16, 2018

    SCIF Resolves Glitch Behind Incorrect Work Comp Bill Denials

    Several providers recently received incorrect denials of bills from California’s State Compensation Insurance Fund (SCIF), the state’s largest provider of work comp insurance. These original bills were denied for untimely submission, despite having been submitted within the required timeline. Senate Bill 1175 mandates a 12-month deadline for original bill submission.

    A SCIF representative acknowledged the error, as the insurer moved quickly to resolve it.

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  • January 4, 2018

    FYI: Fresno County Changes TPA

    Effective January 1, the employer County of Fresno transferred all claims from third-party administrator (TPA) Risico Claims Management, Inc. to Acclamation Insurance Management Services (AIMS). The change applies to all dates of service.  All claims transferred to AIMS retain the same claim numbers used under Risico.

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  • December 19, 2017

    Audit Complaints: Work Comp Providers Demanded Compliance in 2017

    DaisyBill providers stood firm in demanding timely, correct payments in 2017 by using our Audit Complaints Tool to report payor noncompliance.

    We always advocate for compliance on both sides of the workers’ comp transaction. That said, the consequences for provider violations are immediate and automatic, while the payors (insurers, self-insured employers, and their claims administrators) are subject to repercussions only when the Division of Workers’ Comp (DWC) takes action.

    This year, our providers submitted almost 3,000 Audit Complaints, alerting the DWC when claims administrators failed to follow regulations. The data on this year’s violations help paint a picture of which infractions create the most friction for providers.

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  • December 7, 2017

    CA Appeals Court: Providers Do Not Need to Return Overpayments

    Our recent blog post on overpayments generated a number of requests from providers for verification that, absent fraud, refunds are not due to employers or insurers, even in cases where the claims administrator overpaid. In that post, we explained that there are no legislative statutes addressing the return of funds; therefore, legally, no refunds are due.

    We wrote that previous post in response to some reported aggressive behavior from claims administrators attempting to recover monies already paid, including threats of legal action against providers.

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  • December 4, 2017

    Alert: Patriot National, Inc. and Guarantee Insurance Co. Threatened Collapse

    Patriot National Inc., an end-to-end insurance services business that includes third-party administrator Patriot Risk Services, recently defaulted on its debt and laid off about a third of its employees. The implosion of Patriot National is due to the insolvency of its largest client, Guarantee Insurance Co., a national work comp carrier active in 31 states.

    The twin implosions accompany revelations about the questionable dealings of Steve Mariano, a central figure in both companies. Providers should be on alert when billing either Patriot Risk Services or Guarantee Insurance Co.

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  • November 3, 2017

    Why Work Comp e-Bills Require Multiple Clearinghouses

    Here’s a question we often get: “Our office sends our electronic bills to a clearinghouse. Why do so many of them never reach the insurance carrier?”

    Clearinghouses claim to scrub and electronically submit bills to all payors, theoretically making them easy to pay. In reality, clearinghouses often mismanage e-bill delivery, resulting in delayed or outright lost bills. We know this first-hand — not only do we hear constant “lost bill” stories from providers, we’ve had our own bad experience.

    This post is a cautionary tale about how providers cannot rely on a single clearinghouse.

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  • October 31, 2017

    Reports: The Metrics that Matter for Work Comp Providers

    At DaisyBill, we recognize that providers are running a business.

    For injured workers to get the care to which they’re entitled by California law, provider offices count on correct, timely payment. To that end, we track important metrics that shed light on what’s working — and what’s not — for our providers’ bottom lines. With so much data, and so many complex rules and regulations for billing and payment, deciding which analytics to focus on can be a challenge. Below are metrics that should matter to your office.

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DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

Drop us a line with any news you would like us to share or any issue that concerns you.

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