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