Consider this a public service announcement: Broadspire representatives repeatedly gave false e-billing instructions to providers. Additionally, Broadspire representatives falsely claimed e-bills compliantly sent to Broadspire were ‘not-on-file.’

Broadspire, a third-party claims administrator (TPA), failed to pay several daisyCollect provider clients’ e-bills. When daisyCollect called Broadspire, the TPA falsely claimed:

1. Broadspire didn’t receive the e-bills, and
2. daisyBill used an incorrect Payer ID when sending the e-bills (which is demonstrably untrue).

Both Broadspire claims are patently and wholly false, based on the following facts:

1. Broadspire sent daisyBill electronic receipts verifying that Broadspire received the e-bills (sorry Broadspire, ‘lost-in-the-cloud’ never works for e-bills).
2. To transmit e-bills to Broadspire, daisyBill used E8088, the Payer ID assigned to Broadspire by its clearinghouse vendor, Carisk.

In the era of workers’ comp electronic billing, Broadspire missed the memo that claims administrators can no longer creditably claim non-receipt of e-bills compliantly sent by providers. For each e-bill, California e-billing regulations require Broadspire to send the provider an electronic acknowledgment verifying that Broadspire accepted the e-bill for processing.

Besides falsely claiming nonreceipt of an e-bill, Broadspire representatives are undermining workers’ comp e-billing by instructing providers to use an incorrect Payer ID when sending e-bills to Broadspire’s clearinghouse vendor, Carisk.

daisyBill wants to know: Is it fraud to falsely deny receipt of e-bills that Broadspire clearly received? Is it fraud to disseminate an incorrect electronic Payer ID (which is akin to disseminating an incorrect physical mailing address for non-electronic bills)?

Clearinghouse Vendors and Payer ID Numbers, Explained

As we explain in detail in this post, while some claims administrators, like CorVel, accept and process e-bills completely in-house, the majority of claims administrators employ clearinghouse vendors to accept e-bills sent by providers.

Since Broadspire employs clearinghouse vendor Carisk, the following are the established and compliant e-billing steps when daisyBill sends an e-bill to Broadspire:

1. daisyBill sends the provider’s Broadspire bill to Carisk using the Payer ID that Carisk assigned to Broadspire (E8088).
2. Carisk accepts the provider’s e-bill on behalf of Broadspire.
3. Carisk forwards the bill data to Broadspire for processing.
4. Carisk sends daisyBill a verifiable electronic receipt, acknowledging that Broadspire received the ebill.
5. Broadspire sends the Explanation of Review (EOR) data to Carisk, and Carisk returns an EOR electronically to the daisyBill client.

By law, when a provider sends an e-bill, a claims administrator (or its clearinghouse vendor) must electronically send a provider both an EOR and payment within 15 working days from receipt of a provider’s e-bill.

Broadspire Falsely (Fraudulently?) Blames Provider

When Broadspire failed to send payment or an EOR to a daisyCollect client, our agent called Broadspire for an explanation.

The Broadspire representative falsely reported never receiving the e-bill.

Wait, what? WT…? Broadspire’s clearinghouse, Carisk, sent daisyBill an electronic receipt verifying that Broadspire received the e-bill in question, as the screenshot below shows.

Incredibly, the Broadspire representative also falsely claimed the Carisk Payer ID E8088 was an incorrect Payer ID for Broadspire.

Wait, what? WT…?  The representative falsely instructed that the correct Payer ID is TP021, a long-outdated Payer ID for Broadspire’s previous clearinghouse vendor, Availity.

In June 2021, Broadspire switched clearinghouse vendors from Availity to Carisk. With the clearinghouse switch, Broadspire also switched its Payer ID to the new ID assigned by Carisk: E8088. Below is a screenshot from a marketing email sent by Carisk, announcing Broadspire’s switch and new Payer ID.

And below is a screenshot from daisyBill, showing that the bill in question was submitted using the correct Carisk Payer ID, E8088.

If you wish to hear a Broadspire representative disseminate false information for yourself, below is the transcript and RECORDING of our agent’s call with Broadspire.

Broadspire’s e-Billing Ineptitude

That Broadspire could get something as critical as their own Payer ID wrong is mind-numbing.

For a Broadspire representative to lack such fundamental information speaks to the broader problem of non-enforcement of California workers’ comp billing laws and regulations. What incentive does Broadspire have to provide accurate billing information to providers, if there are no consequences for doing otherwise?

Stay tuned for how daisyBill is managing this Broadspire noncompliance (fraud?) on behalf of our clients.

daisyBill knows the rules — even though claims administrators don’t always follow them. Reach out to learn how our technology and expertise can protect your revenue from payer noncompliance.

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