AmTrust Changes Clearinghouse, (Finally) Gets Compliant

AmTrust Changes Clearinghouse, (Finally) Gets Compliant

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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