There’s no excuse for claims administrators not to accept and properly process electronic bills, a legal requirement in California for almost 10 years now. Every claims administrator can meet this requirement if they’re willing to maintain the technical ability — as Berkshire Hathaway Homestate Companies (BHHC) recently demonstrated.
BHHC had a serious problem with not returning electronic Explanations of Review (e-EORs) to providers in response to e-bills. One of the most basic requirements of e-billing, e-EORs are the final step in the process, as they close the electronic loop and automatically post payment details to the provider’s e-billing software.
For the first five months of 2022, BHHC failed to return e-EORs at between 28% and 40% of the time. These e-bills were either unpaid, or the provider received non-compliant paper EORs requiring unwarranted time and effort to post manually.
But the most recently available data tells us that BHHC now fails to send an e-EOR only 2% of the time — an incredible improvement that helps make workers’ comp a better financial proposition for providers, and helps improve injured workers’ access to care.
Previously, we decried BHHC’s bad habit of complying with California e-EOR requirements sometimes. Particularly in response to Second Review appeals, BHHC was in consistent, blatant violation of the state mandate to send an e-EOR in X12 835 format within 15 working days (for original bill submissions) or 14 calendar days (for Second Review appeals) of receipt of an e-bill.
Far, far too often, BHHC not only failed to timely return e-EORs, but failed to return any e-EOR whatsoever. But over the summer, BHHC dramatically cleaned up its act; the insurer’s missing e-EOR rate plummeted to 2%, from a 2022 high of 40%.
We applaud BHHC for so drastically improving its compliance with California law. But as we were compelled to note when discussing AmTrust’s recent improvement, 0% non-compliance should be the goal.
BHHC’s final 2% rate of e-EOR non-compliance for July represents 126 e-bills. While that’s not very many, it cannot be acceptable for even one doctor to either a) not be paid for treating an injured worker, or b) be forced to waste practice time and resources to account for a payer’s technical screw-up.
That said, kudos to BHHC. We look forward to the (hopefully imminent) announcement that the insurer returns compliant e-EORs 100% of the time.
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