To treat injured workers, providers nationwide need the most up-to-date billing information.

That means providers need to track which claims administrators are responsible for paying for injured workers’ treatment and which clearinghouse vendors the claims administrators use to accept electronic bills.

daisyBill has spent the last decade-plus constructing a complete database of claims administrators and clearinghouse vendors to facilitate e-billing for providers who use our software.

Below, we share the latest changes to claims administrator and clearinghouse information to help all workers’ comp providers, just as we help our clients.

Employer Claims Administrator Updates

The claims administrator updates below reflect all changes since the last update daisyNews published in October 2024.

As of the ‘Effective Date’ listed, the employers below no longer use the ‘Prior Claims Administrator’ to manage their workers’ comp claims; instead, they use the ‘Current Claims Administrator.’

All the employers listed below switched from various claims administrators to Third-Party Administrator (TPA) CorVel.

CorVel is unique among claims administrators. Unlike all other claims administrators (except the US Department of Labor), CorVel does not use a clearinghouse vendor to accept and respond to providers’ electronic bills (e-bills).

Instead, CorVel has the technology to compliantly accept e-bills on behalf of its clients, which include insurers and self-insured employers. Similarly to a clearinghouse, CorVel assigns its clients a unique Payer ID. When submitting e-bills to CorVel, providers should use the Payer IDs assigned by CorVel.

Electronic Billing Clearinghouse Update

Following twelve years of non-compliance with California state law requiring claims administrators to accept workers’ comp e-bills from providers, Pacific Claims Management has finally complied. Starting in November 2024, this TPA will accept e-bills from providers who treat injured workers.

Providers should send Pacific Claims Management e-bills to Data Dimensions, the TPA’s designated clearinghouse vendor.

Glossary of Terms

Claims Administrator: The claims administrator manages injured workers’ claims, including overseeing medical bill payments. The claims administrator may be:

• The employer’s workers’ comp insurer
• A self-insured employer, if the employer self-administers its claims
• A TPA engaged by the insurer or self-insured employer to manage claims

Clearinghouse: With the exceptions of CorVel and the US Department of Labor, claims administrators do not have the technical capability to accept and respond to providers’ e-bills. For that reason, claims administrators hire clearinghouse vendors to perform the following functions:

• Accept providers’ e-bills on behalf of the claims administrator.
• Return electronic acknowledgments to providers, documenting receipt of e-bills and indicating if the e-bills were accepted for payment.
• Electronically send Explanations of Review (e-EORs) to providers, automatically posting payment details to the provider’s billing system.

Payer ID: Clearinghouse vendors assign this unique identifier to their claims administrator clients, so the clearinghouse can correctly route providers’ e-bills to the client.

To successfully send a workers’ comp e-bill, a provider should submit it to the claims administrator’s designated clearinghouse vendor using the Payer ID assigned to the claims administrator.

Remember, however, that CorVel is a unicorn. This claims administrator does not use a clearinghouse; submit e-bills directly to CorVel using the Payer ID CorVel assigns.

Confused? That’s understandable.

daisyBill spent years developing the technology necessary to correctly deliver workers’ comp e-bills to the right clearinghouse, CorVel, or DOL with the correct Payer ID. We worry about this stuff so our clients don’t have to!

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