On Tuesday, October 9, Optum Property and Casualty Clearinghouse suffered a major systems issue, preventing Optum from receiving, processing, or responding to electronic bills from providers. The shutdown persisted for a week, until Optum was able to restore systems on Tuesday, October 16.
The Clearinghouse Role
While California law mandates that all claims administrators accept electronic bills for workers’ comp services, many claims administrators lack the technology to process electronic bills. Hence the need for clearinghouses, which are central electronic hubs that connect providers and claims administrators statewide.
In California, claims administrators use one of five different clearinghouses, some excellent, some appallingly inefficient. The DWC requires providers who bill electronically to establish a direct electronic route to the claims administrator's chosen clearinghouse. Therefore, sending electronic bills to the wrong clearinghouse is non-compliant and can preclude payment.
DaisyBill establishes and maintains the necessary direct electronic routes for all clearinghouses to make electronic billing as easy as it was meant to be. However, as in all things workers’ comp, things don’t always go smoothly on the clearinghouse end.
Optum Operations, Interrupted
According to Optum, the systems error occurred after 7:30 p.m. ET on Tuesday, October 9th. The system was brought back online at 12:15 p.m. ET on Monday, October 15. However, certain problems regarding File Transfer Protocol (FTP) permissions persisted until Tuesday, October 16th. Optum has not yet discovered the root cause of the problem.
During the shutdown, Optum stayed in constant contact with partners and clients, keeping everyone up to speed on the progress of their repairs. While the sudden inability of countless providers to submit bills and receive responses was extremely concerning, Optum displayed appropriate levels of transparency and communication as they scrambled to restore order.
The incident highlights the importance of reliable electronic billing and payment management, and the need for providers to be prepared for the pitfalls of workers’ comp. Thorough, efficient, workers’ comp-specific billing software doesn’t just make treating injured workers easier — it can protect your data (and possibly your office’s revenue) when things go screwy on the payor side of the equation.