Blog: Daisy News

News, data, & insights about workers' comp billing

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  • June 15, 2018

    Clearinghouses Under the Microscope: CorVel Corporation

    Most claims administrators lack the technology to process electronic bills from providers. Instead, these claims administrators rely on clearinghouses. Since DaisyBill has direct access to all 5 California clearinghouses, we’re uniquely qualified to evaluate and compare the performances of each. With this series, we take a look at the value each clearinghouse adds to (or subtracts from) workers’ comp.

    To kick this clearinghouse series off, we’ll start with the most efficient kind of clearinghouse: no clearinghouse at all.

    Corvel Corporation is not a clearinghouse, per se. But CorVel is something even more important: a claims administrator that essentially functions as its own clearinghouse, directly accepting and processing providers’ e-bills. This vastly reduces complications and potential friction for providers and employers, both of whom benefit from CorVel’s integrated approach.

    We applaud any time a claims administrator’s practices make things simpler for all concerned. By taking on the duties of a clearinghouse, CorVel sets a new standard of efficiency.

     

    Read more →

  • June 8, 2018

    CorVel Error: Incorrectly Reimbursed ASC Services

    CorVel Corporation, a national third-party administrator, incorrectly reimbursed multiple California workers’ comp providers for Ambulatory Surgical Center (ASC) services, at rates established by Medicare’s ASC fee schedule.

    Medicare ASC reimbursement rates are not applicable to California workers’ comp. Fortunately, DaisyBill clients alerted us to the problem.

    We reached out to CorVel, whose representatives acknowledged the error. Working proactively with DaisyBill, CorVel updated their payment practices and agreed to reprocess all bills with dates of service 3/15/2018 through 5/22/2018.

    Where applicable, CorVel will send providers additional payment for incorrectly processed bills.

    Read more →

  • June 1, 2018

    Multiple Payors Reimbursing WC002 at 2017 Rates

    We’re halfway through 2018, and claims administrators are still reimbursing your office at 2017 rates for 2018 dates of service.

    We’ve noticed this problem all year for various billing codes. We’ve called on claims administrators to update their systems to reflect California’s current Official Medical Fee Schedule (OMFS). Now, inexplicably, we see a particular code (WC002) paid at 2017 rates for 2018 dates of service — even as other codes on the same bill are paid correctly.

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  • April 20, 2018

    York Risk Services Must Treat CA Providers Better

    DaisyBill strives to make workers’ comp billing and payment smoother for both providers and payors.

    We work with thousands of payors, including employers, insurers, and third-party administrators across California to electronically submit over 1.25 million compliant bills annually. We’ve seen good behavior and bad from payors. But we’ve never heard of a more frustrating experience than the one providers endure with York Risk Services — an experience we’ve endured ourselves.

    When York fails to respond to bills for treating injured employees, providers report facing an infuriating uphill battle to track those bills. We strongly encourage medical billers to alert their providers about York’s unnecessary payment friction.

    York can (and should) do better to help providers.

    Read more →

  • March 22, 2018

    Macy’s Changes Bill Review; Sedgwick Error Causes Bill Rejections

    Self-insured employer Macy’s no longer utilizes EK Health Bill Review. Effective March 3, 2018, Macy’s switched to Sedgwick Claims Management Services National Bill Review.

    Sedgwick provided new electronic payor ID numbers for Macy’s and its affiliated stores, but those ID numbers ultimately proved incorrect. DaisyBill investigated and secured the correct ID from Sedgwick’s clearinghouse, Optum.

    Read more →

  • March 16, 2018

    TPA Change: JCPenney Switches Third-Party Administrator

    JCPenney no longer utilizes third-party claims administrator Sedgwick Claims Management Services. The retail department store chain transferred all claims to AIG Claims, Inc., effective February 2, 2018.

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  • March 16, 2018

    FYI: American Airlines Changes Bill Review

    Self-insured employer American Airlines no longer utilizes Genex Services Bill Review. Effective February 1, 2018, American switched to Sedgwick Claims Management Services National Bill Review.

    Read more →

  • February 23, 2018

    VPay Error Impacts Thousands of Sedgwick EORs

    VPay, a payment processing company which issues explanation of reviews (EORs) and virtual credit card payments from claims administrators to providers, suffered a technical glitch in early November 2017.  VPay did not timely send thousands of EORs denying payment from Sedgwick Claims Management Services.

    To rectify the glitch, VPay recently flooded providers with EORs denying payment on Sedgwick’s behalf. Some of the EORs recently received by providers are dated as far back as November.

    Crucially, these EORs are backdated to the date processed, rather than reflecting the date on which VPay actually sent the EORs out. This falsely alters the timeline, potentially narrowing or closing the timeframe in which providers may request second review. Providers should review these EORs, submit timely requests for second review where necessary, and submit audit complaints regarding Sedgwick’s flagrant violation of relevant Labor Codes.

    Read more →

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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.