In a recent article, Broadspire Defies CA Law and Denies Appeals Sent by Providers, we described Broadspires’ success in defying California workers’ comp laws without consequences. Despite California regulations to the contrary, Broadspire refuses to accept Second Review appeals transmitted electronically by California providers.

Broadspire's brazen defiance went even further: when a provider acquiesced and mailed a Second Review appeal, Broadspire denied the appeal as untimely. Below is the audit complaint filed with the California Division of Workers’ Compensation (DWC), explaining the failings of Broadspire to compliantly adhere to California laws, regulations, and rules.

Unfortunately for providers, an Audit Complaint is the single, free option available to providers to document the inequities of California workers’ comp. Fortunately for providers, the California DWC takes these Audit Complaints seriously; the DWC will pursue enforcement of laws, regulations, and rules when adequate proof is provided exposing claims administrator noncompliance.

A list of employers impacted by Broadspire’s noncompliance is also noted below.

Second Review Appeals to Dispute Incorrect Reimbursements

Broadspire uses the clearinghouse known as Availity to accept workers’ comp bills transmitted electronically to Broadspire. On 8/14/2020 Availity reported to DaisyBill that its client, Broadspire, in defiance of California regulations, refused to accept Second Reviews transmitted electronically. 

According to Availity, its client Broadspire:

1. Requires providers to mail their Second Review appeals, which ignores California regulations.
2. Implements its own Second Review rules -- except those rules don’t actually exist. Broadspire requires Second Review to include EORs, despite the fact that California regulations do not require an EOR to dispute an incorrect payment. Once again, Broadspire ignores California regulations, and, in fact, makes up its own rules.

The California regulation is clear. Per CCR § 9792.5.5.(c)(2): For an electronic medical treatment bills [sic] for professional, institutional or dental services, the request for second review shall be submitted on the correct electronic standard format… (emphasis added)

Audit Complaint Filed With DWC

Broadspire’s refusal to accept Second Reviews electronically directly defies the mandated responsibility of a claims administrator to accept electronic transmission of Second Review appeals when the provider submitted the original bill electronically. This is not a new development: back in January of 2014 we called attention to Broadspire’s non-compliant demand that providers fax Second Review appeals rather than transmit these appeals electronically.

In DaisyBill we make it super easy for providers to file Audit Complaints with the DWC.

Provider 100% Compliant. Broadspire 100% NONcompliant

While this provider is 100% compliant in its management of Second Review appeals, Broadspire is 100% noncompliant in its management. These Audit Complaints often focus on details of noncompliance in bill processing, because claims administrators’ noncompliance drowns workers’ comp providers in roadblocks, denials, and extra administrative hurdles.

Below we demonstrate the effort required of this provider to attempt to collect the correct reimbursement as guaranteed by the California Official Medical Fee Schedule (OMFS). After refusing to accept Second Review appeals, unbelievably, Broadspire returns an electronic EOR responding to the mailed Second Review appeal.

Broadspire denies mailed Second Review appeal as untimely.

Workers Impacted by Broadspire Friction

Our hope is that the employers who read these articles will choose to avoid those insurers and third-party administrators that flaunt California laws -- laws put in place to protect providers who treat the employer’s injured employees.

This Broadspire defiance is another sign of the erosion of fairness in the workers’ compensation system -- a system that should protect providers and claims administrators equally but seems to disproportionately and tacitly allow claims administrators to disregard all applicable rules without consequence.

Below is the list of employers where Broadspire refused to accept an electronically transmitted Second Review appeal.

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

* The California Division of Workers’ Compensation Medical Billing and Payment Guide requires that providers furnish the name of the employer of the injured worker when submitting a bill for services. Below are the employer names furnished by DaisyBill clients for the mailed Broadspire Second Review Appeals. Clients may use different versions of any given employer name.

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