Just when we think we’ve seen it all, California claims administrators find new ways to create obstacles to payment.

AmeriTrust is rejecting valid electronic bills (e-bills) for medical treatment based on… spacing. Not missing documentation, incorrect billing codes, or any other legitimate issue—just spacing.

AmeriTrust’s clearinghouse vendor, Data Dimensions, confirmed to daisyBill that if a provider submits an e-bill and the claim number is missing a required space, AmeriTrust will not process the e-bill.

Per Data Dimensions, the AmeriTrust claim number pattern is as follows: AAAA99999999 01 (notice the space between the last ‘9’ and the ‘01’).

• Data Dimensions will reject AmeriTrust e-bills when the claim number does not include the space (e.g., AAAA9999999901)
• Data Dimensions will accept AmeriTrust e-bills when the claim number includes the space (e.g., AAAA99999999 01)

When daisyBill made multiple calls to AmeriTrust to confirm claim numbers, the AmeriTrust representatives never mentioned the required space.

Every time a claims administrator like AmeriTrust pulls this kind of nonsense, it introduces more friction and more payment delays for treating providers. That puts additional strain on practices already struggling to navigate California’s byzantine workers’ comp system.

More importantly, AmeriTrust’s behavior jeopardizes the care of all injured workers. Denying or delaying payment for legitimate treatment bills discourages providers from participating in the system—ultimately limiting treatment options for everyone.

AmeriTrust’s Bizarre Spacing Demands

In e-billing, the clearinghouse accepts and responds to e-bills on the claims administrator’s behalf. In response to a provider’s e-bill, the clearinghouse sends a ‘277’ Acknowledgement (277 ACK) that confirms that the clearinghouse received a provider’s e-bill.

• A 277 ACK indicating ‘Accept’ means that the clearinghouse forwarded the e-bill to the claims administrator for processing.
• A 277 ACK indicating ‘Reject’ means that the clearinghouse did not accept the e-bill or forward it to the claims administrator for processing.
  

As the screenshot below from daisyBill shows, Data Dimensions twice accepted a provider’s clean, compliant AmeriTrust e-bill submission—only to later send the provider a 277 ACK rejecting the bill.

AmeriTrust - Petty Excuses for Denying Payment to Doctors

The stated reasons Data Dimensions listed in the 277 rejections (claims of “Missing Information” and “CLAIM NOT FOUND”) are bogus.

daisyBill contacted Data Dimensions about the multiple faulty AmeriTrust e-bill rejections. According to Data Dimensions, AmeriTrust will not accept e-bills if the last two digits in the claim number are too close together.

daisyBill called AmeriTrust about these rejected e-bills (a sample transcript is below). In each instance, the AmeriTrust agent confirmed it was liable for the injury and reported the claim number and all other information on the e-bill as accurate.

At no point did an AmeriTrust agent instruct providers to include the allegedly essential space in the claim number.

AmeriTrust’s e-bill rejections are worse than an inconvenience—these picayune payment barriers go against the impetus for California’s mandate that claims administrators accept e-bills—to improve efficiency and access to care for injured workers.

AmeriTrust’s pointless, seemingly arbitrary spacing requirements undermine the intent of California legislators and needlessly inflict payment torture on the providers still willing to treat injured workers.

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