Berkshire Hathaway Homestate Companies (BHHC) is backsliding into old, bad habits.

Over the summer, BHHC failed to send thousands of electronic Explanations of Review (e-EORs) in response to providers’ electronic bills, forcing daisyBill to submit formal Audit Complaints to the California Division of Workers’ Compensation (DWC).

e-EORs are a critical requirement of e-billing; these electronic files from the claims administrator automatically post payment details to the bills in the provider’s system, saving countless hours of manual work by practice staff.

BHHC failed to remit 10,735 e-EORs from January to August of 2023. This severe lapse follows our call last year for the DWC to conduct a Target Audit of BHHC due to its consistent violations.

We urge the DWC to fulfill its role as a state regulator and take appropriate action to incentivize BHHC to adhere to California electronic billing regulations.

BHHC Violations Spike

In July, when daisyBill agents noticed a drastic uptick in the number of missing e-EORs for our provider clients’ bills, we reached out to Medata, BHHC’s bill review vendor (Medata had previously requested daisyBill alert Medata of e-billing issues with BHHC).

Medata first reported that BHHC had identified the problem and assured our representatives that a resolution was underway. However, the missing e-EORs did not materialize.

The problem worsened; BHHC failed to send e-EORs for 79% of e-bills sent in August.

As of this writing, 10,735 e-bills are missing e-EORs from BHHC — which means either these bills were not paid or the providers were robbed of the significant amount of time and practice resources necessary to post the payments manually.

Below is the formal Audit Complaint submitted by daisyBill to the DWC.

Audit Complaint

To: XXXXXXXX@dir.ca.gov

Subject: BHHC EDI Non-compliance: X12 835 Missing - Count 10,735

Below is an Audit Complaint reporting credible data that Berkshire Hathaway Homestate Companies (BHHC) failed to send 10,735 electronic EORs (X12 835) to daisyBill providers as mandated by California law. The “Communications History” table demonstrates that in August 2023, daisyBill informed the bill review vendor, Medata, that BHHC failed to send electronic EORs to providers. Despite the outreach by daisyBill, BHHC continues to ignore California EDI requirements.

On April 19, 2023, daisyBill filed 4,353 Audit Complaints against BHHC for failing to adhere to California EDI requirements: Berkshire Hathaway: 4,353 Audit Complaints Submitted.

A provider's receipt of an electronic EOR (X12 835) is a critical component of electronic billing for the following three reasons:

1. The electronic EOR closes the payment loop for a workers’ comp e-bill, and
2. Automatically posts to the respective e-bill, thereby significantly reducing a provider's administrative burden of manually recording payment information to the respective e-bill, and
3. Allows the gathering of essential payment data about the claims administrator contained in paper EORs mailed to individual providers.

This Audit Complaint data represents 10,735 California workers’ comp e-bills submitted to BHHC by daisyBill providers from January 1, 2023 through August 31, 2023 where BHHC failed to return the required electronic EORs (X12 835). Below is a table listing the monthly percentage of e-bills where BHHC failed to send an electronic EOR to providers.

Attached is a CSV list containing 10,735 e-bills providers submitted where BHHC failed to return a mandated electronic EOR to the provider. The attached CSV list includes the following columns:

• Column L: [Bill] Transmission Date
• Column W: EOR (835) Compliance Due Date
• Column X: 835 EOR: Receipt Date - This column is BLANK because BHHC failed to send the provider an electronic EOR (835).
• Column AO: Patient Name
• Column AP: Claim Number

On 8/31/2023, daisyBill emailed Medata representatives to report the lack of compliance. A single representative responded, as noted below, and the representative failed to provide any additional information regarding rectifying the BHHC non-compliance:

9/6/2023 Medata Response:
“I've talked w/ BHHC's Acc't Mgr and understand a delay in 835 distribution was discovered for July. The Medata team worked to clear up the backlog of 835s. I understand that as of this past Friday, 09/01/2023 all backlogged 835s have been distributed to BHHC's respective EBill Clearinghouse vendors. The 2 key vendors (Carisk and WorkCompEDI) generally distribute 835s within 1 - 2 business days upon receipt. As a result, this week you should see a large influx of retrospective BHHC 835s.”

9/21/2023 Medata Response:

“This is puzzling to me, as I had understanding the 835 process reconciled by now and caught up.

I’m going to reach out internally to the BHHC Acc't Manager, as well as reach out to Carisk to see if they're encountering any delays in distribution. I'm sorry you're experiencing these delays.”

Audit Complaint Details

This Audit Complaint Data submitted to the DWC represents a credible complaint and credible information of claims handling violations. Per Title 8, California Code of Regulations section 10111.2(b)(10),(11), BHHC should be subject to audit penalties.

EDI Non-compliance: Claims administrator failed to send an electronic Explanation of Review (EOR) in the mandated ASC X12N/005010X221A1 (835) format, despite the claims administrator sending a 277 Acknowledgement accepting the Original Bill / Second Review Appeal.

DWC Rule 7.1 requires the claims administrator to electronically send an EOR to the provider using the X12 835 EDI standard within 15 working days of receipt of an e-bill.

Per California DWC Medical Billing and Payment Guide 7.2, any electronically submitted bill determined to be completed, not paid, or objected to within the 15 working day period, shall be subject to audit penalties per Title 8, California Code of Regulations section 10111.2(b)(10),(11).

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