Alert: 12 False e-Bill Rejections - Contra Costa County

Alert: 12 False e-Bill Rejections - Contra Costa County

Providers electronically billing Contra Costa County Risk Management (CCCRM) and Contra Costa County Schools Insurance Group (CCCSIG), be advised that the clearinghouse utilized by these claims administrators is erroneously, systematically rejecting provider e-bills.

A clearinghouse is a vendor hired by the claims administrator to respond to providers’ e-bills on the claims administrator’s behalf. When the clearinghouse incorrectly rejects a compliant e-bill, the clearinghouse does not forward the e-bill to the claims administrator; therefore, the claims administrator cannot pay the e-bill.

Currently, the clearinghouse Data Dimensions (formerly WorkCompEDI) is falsely rejecting e-bills sent by providers for CCCRM and CCCSIG. daisyBill has contacted Data Dimensions as follows:

  • On 5/5/2022, daisyBill alerted Data Dimensions that it was falsely rejecting e-bills providers submitted to these claims administrators.
  • Communication received from the Data Dimensions indicates CCCRM and CCCSIG are generating the false e-bills rejections. Data Dimension asserts that the claims administrators are responsible for the false e-bill rejections. As of 5/16/2022, this e-billing non-compliance remains unresolved.

When a clearinghouse falsely rejects an e-bill submitted by one of our clients, daisyBill undertakes the following steps:

  1. Designates the e-bill with a DaisyBill Researching status
  2. Contacts the claims administrator’s clearinghouse to report the false e-bill rejection
  3. Resubmits the rejected e-bill on behalf of our client once the clearinghouse reports fixing the error,
  4. Monitors the e-bill until it is ultimately accepted by the clearinghouse and sent to the claims administrator for processing
  5. Appends a Non-Compliance Alert to each e-bill history affected by the EDI error

In order for providers to resubmit falsely rejected e-bills for payment, the claims administrator, bill review, and/or clearinghouse entities must repair the underlying technical error causing the improper e-bill rejections.

Ultimately, California law and regulators hold CCCRM and CCCSIG responsible for their e-billing non-compliance, regardless of the failures of any of their vendors. Per the California Division of Workers’ Compensation (DWC) Electronic Medical Billing and Payment Companion Guide:

Billing agents, electronic billing agents, third party administrators, bill review companies, software vendors, data collection agents, and clearinghouses are examples of companies that may have a role in electronic billing. Entities or persons using agents are responsible for the acts or omissions of those agents executed in the performance of services for the entity or person. [emphasis added]

When a claims administrator fails to adhere to California e-billing requirements, daisyBill notifies our clients by appending a Non-Compliance Alert to the Bill History for each e-bill affected by the EDI error, as shown below.

5/16/2022

Details

Claims Administrator Name

Contra Costa County Risk Management (CCCRM)

Contra Costa County Schools Insurance Group (CCCSIG)

Bill Review

CCCSIG

Clearinghouse

Data Dimensions

277 ACK Rejection Count

12 (as of 5/16/2022)

Incorrect Rejection Reason

STC Category: A3 - The bill has been returned as unprocessable.

STC Code: 21 - Missing or invalid information.

STC Category: A3 - The bill has been returned as unprocessable.

STC Code: 116 - Claim submitted to incorrect payer.

In early May, daisyBill discovered that self-insured employer CCCRM and Joint Powers Authority CCCSIG incorrectly rejected e-bills submitted by our clients. All e-bills submitted by daisyBill clients were EDI compliant.

Both of these claims administrators employ Data Dimensions as their designated clearinghouse.

On 5/5/2022 daisyBill alerted Data Dimensions to the 277 ACK rejection error. As of 5/6/2022, Data Dimensions continues to falsely reject e-bills submitted to these claims administrators. (For more information, read How to e-Bill: Improperly Rejected e-Bills Explained).

Communication received from the Data Dimensions indicates the claims administrators are generating the incorrect 277 ACK rejections. Data Dimension asserts that it is not responsible for the false e-bill rejections.

🌼 As of now, daisyBillers do not need to take any action regarding this EDI non-compliance. On your behalf, daisyBill will resubmit all incorrectly rejected bills until the clearinghouse properly responds to these e-bills. Have a Flower Power Day!  

Date

Action

5/4/2022

CCCRM and CCCSIG send incorrect 277 rejections.

5/5/2022

daisyBill reports EDI error to Data Dimensions, the designated clearinghouse for both claims administrators.

5/9/2022

daisyBill reports additional EDI error examples to Data Dimensions.

5/9/2022

Data Dimensions replies: “These are being rejected directly at the payer.”

5/11/2022

daisyBill contacts CCCRM and CCCSIG. Each claims administrator verifies the claim information matches their records, and that there have been no recent changes or issues to their bill review.

daisyBill fights the good fight on behalf of workers’ comp providers. Reach out to see how we can help your practice obtain fast, correct reimbursement for treating injured workers.

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