Over the last several years, providers have sent over 5.2 million workers’ comp bills from DaisyBill. These millions of bills allow DaisyBill to directly witness the management of bills by third-party administrators (TPAs) and the vendors that work for these TPAs, like bill review vendors and clearinghouses that manage the electronic billing for payers.

Given the unique insight afforded by our data, payers including self-insured employers and insurers frequently contact DaisyBill to learn about our experience with TPAs and other vendors.

Unanimously and refreshingly, 100% of these payers call DaisyBill because the payer wants to partner with a TPA and other vendors that will provide the best possible care and outcome for injured employees. When speaking to the actual payers, it becomes clear that workers’ comp should not be adversarial, because both payers and providers want injured employees to get better quickly.  

Usually, these payers have compiled a shortlist of companies being considered and the payers want to “pick our brains” about DaisyBill providers’ experiences with the companies being considered.

Recently, I recommended that a payer should consider adding Definiti Healthcare Management Review to its shortlist of bill reviews. Drawing from our data, I easily supplied the payer with the names of other payers that use Definiti services so that it could call for references.

Below is a real-life Tale of Two Bill Reviews which illustrates the benefits of cooperating to make workers’ comp better versus the outdated and ineffective adversarial approach to workers’ comp.

Definiti Healthcare Management Review

Recently DaisyBill wrote a post about a Definiti Healthcare Management client failing to return the mandated electronic explanations of review (EORs) as required when a provider electronically submitted a bill to the payer. Additionally, the California Division of Workers’ Comp contacted the payer about an Audit Complaint* filed by a DaisyBiller reporting the payer’s breach of duty for failing to electronically return EORs.

Upon learning of the failure to return electronic EORs, Definiti immediately contacted DaisyBill to alert us that solving this problem was the highest priority for this bill review company. After researching the problem Definiti discovered a glitch in the bill review software that it used; this glitch was preventing the proper communication with the clearinghouse required to electronically send EORs.

Rather than becoming defensive, Definiti was proactive, contacting DaisyBill and solving the problem. Most importantly, the payer can now respond to the Audit Complaint and let the DWC know that the payer is now compliant with the mandated electronic billing regulations.

Thanks to the Definiti mindset that is focused on solving a problem, workers’ comp is working better.

Unnamed Bill Review

Also in the past year, DaisyBill published a blog post about another payer and its bill review. This post also indicated that these two entities needed to work out some kinks in the billing information being communicated to providers. Unfortunately, this post elicited a very different kind of response.

Months after the post, each entity directed its respective legal counsel to send a threatening letter to DaisyBill demanding the retraction of the post. The legal counsels for these entities accused DaisyBill of fabricating the reported information, asserting that we did not accurately report the details of the transition.

However, we only reported information that was given to us by representatives of the entities themselves (DaisyBill does not need to fabricate false stories, there are plenty of provider problems for us to call out; there is no need to create counterfeit workers’ comp problems).

Months after the post, we contacted both the payer and bill review and both continue to disseminate incorrect information to providers.

Sadly, this adversarial mindset of this particular pair of payer and bill review make workers’ comp worse.

Workers’ Comp References

Regardless of legal intimidation, we will continue to highlight the good and call out the not-so-good in the workers’ comp community. DaisyBill accepts no advertising nor do we accept monetary remuneration from the companies we recommend in this space. Definiti is not a client of DaisyBill and we received no payment from Definiti for either our referral of it to a payer nor for our input regarding the resolution of the EOR issue.

Payers including self-insured employers and insurers are welcome to contact DaisyBill to find out our experience with the various TPAs and bill review companies. With big transparent data, our mission is to make workers’ comp work better which means injured workers will get better quicker.

*NOTE: The Audit Complaint form was updated in 2019. Access the updated form here: https://www.dir.ca.gov/dwc/Auditref.pdf

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