Workers’ comp billing fails for predictable reasons, including incomplete bill information, missed deadlines, denials and reductions that go unchallenged, and non-responses from payers. Technology purpose-built specifically for comp billing can mitigate all of these.

Why Workers' Comp Billing Can't Run on Standard Software

Group health and Medicare billing are nothing like workers’ comp billing. There are different rules, procedures, payer behaviors, appeal mechanisms, and state-specific requirements.

While great billing software exists for group health and Medicare, trying to shoehorn workers’ comp billing into those systems often leads to failure.

For example, for California and New York clients, daisyBill is programmed with the exact workers’ comp fee schedule rates for the location and date of service, factoring in every variable to arrive at the correct reimbursement, down to the penny. It also auto-populates appeals on the state-mandated forms for California Second Review appeals.

What Are Bill Tasks & Payment Cycle Stages?

As each bill moves through the payment cycle, daisyBill keeps track and automatically prompts practice staff to complete any necessary bill ‘Tasks’ along the way. At any given time, a bill can be in one of several statuses:

1. Incomplete: the bill needs additional required information or supporting documentation before it can be submitted. daisyBill will create a Task to complete the bill.
2. Sent: a clean, compliant bill has been submitted to the payer; daisyBill is awaiting an electronic acknowledgment from the payer, confirming receipt of the bill.
3. Rejected: the payer or its clearinghouse has rejected the bill and refused to process it for payment. daisyBill will create a Task for staff to confirm the accuracy of the bill information, make appropriate corrections, and resubmit the bill, or flag it for our team to investigate where necessary.
4. Accepted: the payer has accepted the bill for processing; daisyBill is awaiting an electronic Explanation of Review/Benefits (e-EOR/EOB). daisyBill will create a Task to follow up if the EOR/EOB does not arrive by the legal deadline.
5. Processed: The payer has returned an EOR/EOB and the payment has been posted to the bill. If the payer underpaid the bill or denied reimbursement, the software gives staff the option to submit an appeal in seconds.

When necessary, bills may be in ‘daisyBill Researching’ Status, meaning that a payer error is holding up your bill, and daisyBill's Compliance Team is investigating on your behalf. For example, if an e-bill is rejected and the provider confirms the bill information is correct, the bill is flagged and the status changes from 'Rejected’ to ‘daisyBill Researching.'

The Account Bill Tasks Page

Inside daisyBill’s Bill Tasks page, daisyBill groups bills with active Tasks assigned to practice staff by Bill Status, with details for each, including:

• The specific Bill Tasks that need completing
• Total count of bills per Task
• Admins only: Balance Due column showing total dollar amount owed across bills with that Task

The page also features counts of Assigned Tasks grouped by the Date of Service or EOR/EOB Post Date (this way, staff can prioritize Tasks for older bills). After clicking into one of those Task groupings, staff can sort the Task list according to:

• Balance Due
• Claims Administrator
• Date of Service
• Patient Name
• Task Due Date
• Task User (assigned team member)

Staff can also filter the Task list to show only Tasks for a certain:

• Claims Administrator
• Billing Provider
• Task Due Date
• Task User (assigned team member)
• Injury State (relevant for multi-state accounts)

Administrators can assign Task types to specific team members, with the assigned team member appearing in every bill’s Task bar. If any team member needs further guidance on how to execute a Task, the camera icon next to any Status or Task opens a short video or Help Article with more details.

At the bottom of the Bill Tasks page, bills currently requiring no action (because, for example, payment is not due yet or daisyBill is investigating) are grouped by Bill Status. Each group shows:

• Bill types within that status
• Total count of bills
• Admins only: Balance Due column per bill type

How Automated Tasks Cut the Workload

daisyBill’s automated workflow catches missing bill information and other compliance errors before your bills go out, so that every submission is complete and clean. If a payer rejects a bill due to incorrect information, daisyBill will generate a Task to have practice staff investigate and resubmit.

Once the e-EOR/EOB arrives, daisyBill automatically posts all the payment information to the bill, no manual input required. If a payer incorrectly denies or reduces your reimbursement, daisyBill’s 30-second appeals make it easy to demand correct payment.

For a full walkthrough of daisyBill’s automated Task-based system, see the replay of our recent 30-minute webinar.

daisyBill makes workers’ comp billing easier, faster, and more accurate. Click below to learn more:

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