Alert: 870+ False e-Bill Rejections - Benchmark Insurance Co

Alert: 870+ False e-Bill Rejections - Benchmark Insurance Co

Providers electronically billing Benchmark Insurance Company, be advised that the clearinghouse utilized by this claims administrator is erroneously and systematically rejecting provider e-bills.

A clearinghouse is a vendor hired by the claims administrator to respond to providers’ e-bills on the claims administrator’s behalf. When the clearinghouse incorrectly rejects a compliant e-bill, the clearinghouse does not forward the e-bill to the claims administrator; therefore, the claims administrator cannot pay the e-bill.

Currently, the clearinghouse Data Dimensions (formerly WorkCompEDI) is falsely rejecting e-bills sent by providers for Benchmark. daisyBill has contacted Data Dimensions as follows:

  • On 4/14/2022 daisyBill reported to Data Dimensions the improper rejections of e-bills submitted by providers to Benchmark.

  • Communication received from Data Dimensions indicates the reason for the hundreds of incorrect rejections is that Benchmark is mishandling its transition to a new bill review vendor. As of 5/16/2022, this e-billing non-compliance remains unresolved.

When a clearinghouse falsely rejects an e-bill submitted by one of our clients, daisyBill undertakes the following steps:

  1. Designates the e-bill with a DaisyBill Researching status
  2. Contacts the claims administrator’s clearinghouse to report the false e-bill rejection
  3. Resubmits the rejected e-bill on behalf of our client once the clearinghouse reports fixing the error,
  4. Monitors the e-bill until it is ultimately accepted by the clearinghouse and sent to the claims administrator for processing
  5. Appends a Non-Compliance Alert to each e-bill history affected by the EDI error

In order for providers to resubmit falsely rejected e-bills for payment, the claims administrator, bill review, and/or clearinghouse entities must repair the underlying technical error causing the improper e-bill rejections.

Ultimately, California law and regulators hold Benchmark responsible for its e-billing non-compliance, regardless of the failures of any of its vendors. Per the California Division of Workers’ Compensation (DWC) Electronic Medical Billing and Payment Companion Guide:

Billing agents, electronic billing agents, third party administrators, bill review companies, software vendors, data collection agents, and clearinghouses are examples of companies that may have a role in electronic billing. Entities or persons using agents are responsible for the acts or omissions of those agents executed in the performance of services for the entity or person. [emphasis added]

When a claims administrator fails to adhere to California e-billing requirements, daisyBill notifies our clients by appending a Non-Compliance Alert to the Bill History for each e-bill affected by the EDI error, as shown below.

5/16/2022

Details

Claims Administrator

Benchmark Insurance Company

Bill Review

Western Integrated Care

Clearinghouse

Data Dimensions (formerly WC EDI)

e-Bill Rejection Count

876 (as of 5/16/2022)

STC Category

A6 - The bill has been rejected for Missing Information.

STC Code

Property Casualty Claim Number

Note

CLAIM NOT FOUND

In April, daisyBill discovered that Benchmark Insurance Company falsely rejected hundreds of compliant e-bills submitted by our clients with the erroneous rejection reason: CLAIM NOT FOUND.

This claims administrator employs Western Integrated Care as its bill review vendor and Data Dimensions is the designated clearinghouse.

On 4/14/2022 daisyBill alerted Data Dimensions to the 277 ACK rejection error. As of 5/13/2022, Data Dimensions continues to falsely reject e-bills submitted to Benchmark Insurance Company. (For more information, read How to e-Bill: Improperly Rejected e-Bills Explained).

Communication received from the clearinghouse indicates the reason for the incorrect 277 ACK rejections is the claims administrator is mishandling its transition to a new bill review vendor.

daisyBill will be filing an Audit Complaint with the DWC to report the systemic failure of Benchmark Insurance Company to adhere to California EDI law that requires all claims administrators to compliantly accept e-bills from providers that choose to submit e-bills.

🌼 As of now, daisyBillers do not need to take any action regarding this EDI non-compliance. On your behalf, daisyBill will resubmit all incorrectly rejected bills until the clearinghouse properly responds to these e-bills. Have a Flower Power Day!

Date

Action

4/13/2022

Benchmark incorrectly rejects e-bills sent by providers as follows: CLAIM NOT FOUND.

4/14/2022

daisyBill reports EDI error to Data Dimensions, the designated clearinghouse for Benchmark.

4/18/2022

Data Dimensions admits to incorrectly rejecting e-bills. Data Dimensions indicates Benchmark changed their bill review vendor to Western Integrated Care effective 4/4/2022, and e-bills should be sent to a new Payer ID LV191. (Data Dimensions was able to locate a sample workers’ compensation claim in the claims feed).

4/18/2022

daisyBill emails Western Integrated Care Vice President of Operations to confirm e-billing information provided by Data Dimensions.

4/20/2022

No response received from Western Integrated Care Vice President of Operations.

As instructed by Data Dimensions, daisyBill resubmits rejected bills to Payer ID LV191.

4/26/2022

Data Dimension incorrectly rejects resubmitted e-bills sent to Payer LV191. daisyBill alerts Data Dimensions.

4/28/2022

Data Dimensions indicates there is a problem with the claims feed.

5/3/2022

Data Dimensions provides an update: “Thanks for your patience, this has been resolved with Injury Care.”

5/3/2022

daisyBill asks Data Dimensions if daisyBill can resubmit incorrectly rejected e-bills.

5/3/2022

Data Dimensions advises waiting until the following Monday, 5/9/2022.

5/9/2022

daisyBill asks Data Dimensions if the claims feed refresh over the weekend resolved the duplicate records problem.

5/11/2022

daisyBill contacts Western Integrated Care. Western Integrated Care reveals they took over as bill review effective 5/1/2022.

Data Dimensions replies: do not resubmit rejected e-bills; claims feed not updated.

daisyBill fights the good fight on behalf of workers’ comp providers. Reach out to see how we can help your practice obtain fast, correct reimbursement for treating injured workers.

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