Following years of abject failure, insurer AmTrust appears to be getting its act together to honor California workers’ comp payment requirements — but only after daisyBill submitted 39,631 Audit Complaints to the California Division of Workers’ Compensation (DWC) to report 2021 and 2022 non-compliance.

As of July 9, 2022, AmTrust is finally returning electronic Explanations of Review (e-EORs) to providers in response to electronic bills, as required by California payment regulations. The breakthrough follows months of badgering by daisyBill, the aforementioned tens of thousands of Audit Complaints, and a change of clearinghouse by AmTrust, from Availity to Data Dimensions.

AmTrust: A Long Road to Compliance

In April of this year, daisyBill began reporting on AmTrust’s failure to return e-EORs in response to tens of thousands of provider e-bills. With a literal 0% compliance rate on daisyBill’s Claims Administrator Directory, AmTrust seemed oddly committed to flouting this very basic, very crucial e-billing requirement.

Despite daisyBill submitting 31,514 Audit Complaints to the DWC in April 2022, AmTrust continued to ignore California’s e-EOR requirement. When daisyBill attempted to contact AmTrust to determine if or when Amtrust would become compliant, Amtrust refused to communicate with daisyBill, declaring:

“Given this issue was submitted to the DIR [Department of Industrial Relations, which encompasses the DWC] in the form of a complaint, our response to this issue will accordingly be directed to the DIR...”

Following a second batch of Audit Complaints (all 8,117 of them) submitted to the DWC in May, Amtrust announced a change in clearinghouses from Availity to Data Dimensions, effective June 28.

Starting July 9, Amtrust finally (and mercifully) commenced sending daisyBill providers compliant e-EORs in response to e-bills.

While AmTrust got away with years of non-compliance, we must remind readers that in California workers’ comp, when a provider strays out of compliance, claims administrators monetarily penalize the provider by denying the bill as non-compliant.

Since providers cannot penalize AmTrust, the DWC should. More parity in enforcement of California payment regulations is a must.

daisyBill has the technology and expertise to make workers’ comp work better. Reach out to see how we can help your practice obtain fast, correct reimbursement for treating injured workers.

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