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