Major e-Bill Failure for Data Dimensions Clients

Major e-Bill Failure for Data Dimensions Clients

One hundred claims administrators, all of which use Data Dimensions as their designated clearinghouse, are suddenly failing to comply with California e-billing requirements.

Collectively, the number of timely, compliant 277 Acknowledgements (277 ACKs) sent by Data Dimensions on behalf of these claims administrators dropped to a dismal compliance rate of just 49%, leaving hundreds of providers in the dark as to the status of their e-bills.

Within 2 working days of receiving a California provider’s e-bill, California regulations require the claims administrator to send the provider an X12 277 Acknowledgment (277 ACK). This mandated 277 ACK informs the provider that the claims administrator either:

  1. Accepted the e-bill for payment processing, or
  2. Rejected the e-bill and will not process for payment

When daisyBill reached out to Data Dimensions to inquire as to the reason for their clients’ failure to comply with California regulations, Data Dimensions representatives seemed to indicate its clients were at fault, stating “While we understand the frustration this causes, we are reaching out to the payers to determine how we can assist in increasing turnaround time on receiving the 277 responses.”

Below, our data reveal this serious e-billing compliance issue has grown in scale, from affecting roughly 2,000 e-bills to almost 20,000 e-bills as of 5/24/2022.

49% Collective Compliance for 100 Claims Administrators

Most claims administrators employ a clearinghouse like Data Dimensions to return 277 ACKs to providers on the claims administrator’s behalf. However, it is always the claims administrator’s legal responsibility to ensure timely 277 ACKs are sent to the provider, even when the claims administrator uses a clearinghouse to execute that requirement.

When daisyBill contacted Data Dimensions about the lack of compliant 277 ACKs from Data Dimensions clients, the clearinghouse attempted to excuse the non-compliance with a contrived statistic, claiming “We have done an audit of Daisy Bill's [sic] submissions that are missing a 277 and found only 1% have not received a 277 response.” 

Our verified data suggests otherwise. Data Dimensions’ alleged statistic conceals that since May 1st, daisyBill providers did not receive timely, compliant 277 ACKs accepting or rejecting 19,910 e-bills. The data below clearly show the lack of compliant 277 ACKs is not a statistical outlier as indicated by Data Dimensions’ questionable “audit.”

From 1/1/2022 through 4/30/2022, daisyBill providers received compliant 277 ACKs for effectively 100% of e-bills submitted to Data Dimensions clients. For e-bills submitted on or after 5/1/2022, providers have received a compliant 277 ACK response for only 49% of e-bills.

e-Bills sent to Data Dimensions

e-Bill Submission Count

277 ACK Missing/ Late

277 ACK Compliance Rate

1/1/2022 - 4/30/2022

223,068

184

100%

On or After 5/1/2022

39,377

19,910

49%

At the bottom of this post is a complete list of claims administrators that are failing to comply with 277 ACK requirements. For each claims administrator, the list documents the 277 ACK compliance rate for e-bills submitted 1/1/2022 - 4/30/2022, and the current 277 ACK compliance rate for e-bills providers submitted on or after 5/1/2022.

For each e-bill for which the claims administrators listed below failed to timely send daisyBill providers a compliant 277 ACK, daisyBill will submit a formal Audit Complaint to the California Division of Workers’ Compensation (DWC).

CA: Time to Enforce e-Billing Requirements

The DWC can Target Audit claims administrators that systematically ignore e-billing requirements — especially given a trove of credible, irrefutable evidence like the data presented here, and given that the clearinghouse seems to point the finger at the 100 claims administrators and their “turnaround time” for sending 277 responses to providers.

In California, if a provider is a single day late submitting a bill or Second Review appeal, the provider forfeits all reimbursement due. The claims administrator simply denies untimely submissions out of hand, and the claims administrator keeps the reimbursement owed for treating the injured worker.

Likewise, if a provider’s request for Independent Bill Review (IBR) to dispute improper reimbursement is a single day late, the Division of Workers’ Compensation (DWC) simply rules the dispute ineligible, and the claims administrator keeps the reimbursement owed for treating the injured worker.

And yet, this 277 ACK data clearly reveals that claims administrators ignore regulatory mandates to respond to providers’ e-bills. Unlike provider non-compliance, failure to timely respond to or pay providers’ bills has zero monetary consequences for claims administrators.

There is no excuse for this.

For daisyBill providers at least, we have the verifiable, documented, time-stamped records of every electronic transaction made through our system. We are keeping score, and it is past time for the DWC to take action regarding this blatant disregard of California e-billing law.

Below is the Non-Compliance Alert sent to daisyBill clients, followed by the table listing all claims administrators currently out of compliance with 277 ACK requirements.

Details

Claims Administrator(s)

100 Claims Administrators - See list below

Clearinghouse

Data Dimensions

277 ACK Missing Count

8,455 (as of 5/24/2022)

277 ACK Late Count

11,455 (as of 5/24/2022)

In May, daisyBill discovered that many claims administrators failed to send a X12C/005010X214 Health Care Claim Acknowledgment (or ‘277 ACK’ for short) within the mandated two working days. All e-bills submitted by daisyBill clients were EDI compliant.

For all these claims administrators, Data Dimensions is the designated clearinghouse.

daisyBill alerted the clearinghouse as to the 277 ACK missing error (For more information, read How to e-Bill: 277 "Receipts" Empower Providers).

daisyBill is closely monitoring these e-bills and anticipates the claims administrators’ clearinghouse will accept the e-bills for processing and issue the mandated 277 ACK.

The table below summarizes daisyBill’s persistence in monitoring the EDI non-compliance and making sure the entities responsible resolve the error.

🌼 As of now, daisyBillers do not need to take any action regarding this EDI non-compliance. On your behalf, daisyBill will closely monitor the situation until the underlying issue is resolved, and resubmit affected e-bills where necessary. Have a Flower Power Day!  

Date

Action

5/10/2022

daisyBill discovers over 2,000 submissions with missing or late 277 ACK for 83 claims administrators. daisyBill reports EDI error to Data Dimensions, the designated clearinghouse for all 83 claims administrators.

5/11/2022

daisyBill reports additional submissions with missing 277 ACK to Data Dimensions.

5/11/2022

Data Dimensions replies: “I am reviewing this item with IT and will be in touch shortly with an update.”

5/15/2022

Count of missing 277 ACKs increases to over 3,719 for 98 claims administrators.

5/16/2022

Count of late 277 ACKs received: 1,768. Missing 277 ACKs: 1,957

5/17/2022

daisyBill follows up with Data Dimensions regarding resolution status.

Data Dimensions replies: “We have done an audit of Daisy Bill's submissions that are missing a 277 and found only 1% have not received a 277 response. While we understand the frustration this causes, we are reaching out the payers to determine how we can assist in increasing turnaround time on receiving the 277 responses.”

5/24/2022

Count of late 277 ACKs received: 11,455. Missing 277 ACKs: 8,455

Data: 277 ACK Non-Compliance

Claims Administrator

Total e-Bills

Sent 1/1/22-4/30/22

277 Missing/Late

(e-Bills Sent 1/1/22 - 4/30/22)

277 Compliance % (e-Bills Sent 1/1/22 - 4/30/22)

Total e-Bills Sent on or after 5/1/22

277 Missing/Late

(e-Bills Sent on or after 5/1/22)

277 Compliance %

(e-Bills Sent on or after 5/1/22)

Sedgwick Claims Management Services

80,646

55

100%

14,227

6,716

53%

ESIS, Inc.

16,640

16

100%

3,119

1,373

56%

Cannon Cochran Management Services Inc.

10,057

6

100%

1,708

831

51%

Keenan & Associates

6,959

4

100%

1,356

690

49%

Benchmark Insurance Company

2,850

0

100%

1,313

1,001

24%

Athens Administrators

7,434

12

100%

1,286

592

54%

Tristar Risk Management

9,116

2

100%

1,248

622

50%

Los Angeles County Metropolitan Transit Authority (CA)

6,030

4

100%

1,231

563

54%

Adminsure, Inc.

6,032

8

100%

1,041

537

48%

Acclamation Insurance Management Services

5,651

1

100%

999

463

54%

County of Santa Clara (CA)

1,479

0

100%

887

729

18%

County of San Diego (CA)

1,288

5

100%

835

702

16%

LWP Claims Solutions

3,412

1

100%

655

342

48%

CompWest Insurance Company

3,417

3

100%

611

278

55%

Republic Indemnity

3,113

0

100%

607

313

48%

Marriott Claims Service Corp

1,694

0

100%

468

248

47%

Farmers Insurance

2,711

0

100%

455

236

48%

City of Los Angeles (CA)

2,522

15

99%

421

227

46%

City of San Diego (CA)

1,646

1

100%

405

220

46%

American Claims Management, Inc

2,169

2

100%

384

192

50%

CNA Insurance

2,066

2

100%

348

166

52%

Albertsons / Safeway / Vons

1,667

3

100%

308

163

47%

Omaha National Group

1,342

1

100%

273

142

48%

City and County of San Francisco (CA)

2,344

1

100%

268

162

40%

California Insurance Guarantee Association

1,272

0

100%

253

126

50%

Beta Healthcare Group Risk Management Authority

1,577

1

100%

251

107

57%

Sempra Energy Employee Care Services

886

0

100%

216

138

36%

Crum & Forster

931

0

100%

198

94

53%

Intercare Holdings Insurance, Inc.

12,499

7

100%

197

117

41%

Markel First Comp Insurance

894

4

100%

184

107

42%

Homelink Network

776

0

100%

184

65

65%

Meadowbrook Insurance Group

1,095

1

100%

183

103

44%

Nassco / General Dynamics

888

0

100%

178

80

55%

Midwest Insurance

992

0

100%

170

87

49%

Cottingham & Butler Claim Services, Inc.

1,006

0

100%

143

74

48%

City of Los Angeles Department of Water and Power (CA)

709

0

100%

125

63

50%

Broadspire

706

0

100%

124

52

58%

American Equity Underwriters

509

2

100%

124

54

56%

County of San Bernardino (CA)

773

0

100%

120

61

49%

Pacific Gas & Electric

536

0

100%

120

49

59%

Elite Claims Management

805

0

100%

104

46

56%

Charles Taylor TPA

530

0

100%

104

77

26%

Garden Grove Unified School District (CA)

544

0

100%

104

31

70%

Self-Insured Schools of California (CA)

656

4

99%

103

62

40%

Advantage Workers Compensation Insurance Company

675

8

99%

100

48

52%

National Interstate Insurance

476

0

100%

100

52

48%

Fresno Unified School District (CA)

437

0

100%

86

28

67%

Applied Underwriters

515

1

100%

74

34

54%

Contra Costa County Schools Insurance Group (CA)

427

4

99%

73

41

44%

Pegasus Risk Management Services

355

0

100%

67

19

72%

Nordstrom Workers' Compensation

289

0

100%

60

21

65%

Creative Risk Solutions

354

0

100%

57

28

51%

United Heartland

472

0

100%

56

22

61%

Southern California Edison

338

0

100%

55

32

42%

City of Long Beach (CA)

258

0

100%

55

22

60%

Nationwide Insurance Companies

210

0

100%

53

22

58%

Tokio Marine Management

201

0

100%

53

29

45%

City of Torrance (CA)

271

0

100%

52

18

65%

Schools Insurance Authority (CA)

226

0

100%

52

17

67%

Contra Costa County Risk Management (CA)

302

0

100%

50

21

58%

Disneyland Resorts California

370

1

100%

49

22

55%

North Bay Schools Insurance Authority (CA)

178

1

99%

43

18

58%

Workers' Compensation Administrators, LLC

202

0

100%

38

26

32%

Association of California Water Agencies JPIA

195

0

100%

36

23

36%

Constitution State Services

144

0

100%

35

19

46%

City of Burbank (CA)

194

0

100%

34

20

41%

Municipal Pooling Authority (CA)

222

5

98%

31

9

71%

National Casualty Company

126

0

100%

31

13

58%

Midwestern Insurance Alliance

76

0

100%

31

17

45%

Nationwide Agribusiness Companies

198

0

100%

27

16

41%

Innovative Risk Management

98

0

100%

24

7

71%

Redwood Empire Schools Insurance Group (CA)

90

0

100%

21

10

52%

Murphy and Beane

200

0

100%

20

12

40%

City of Riverside (CA)

150

0

100%

19

9

53%

City of Glendale (CA)

112

0

100%

19

14

26%

Loma Linda University (CA)

38

0

100%

19

13

32%

Amerisure

38

0

100%

19

10

47%

Vanliner Insurance Company

126

0

100%

18

6

67%

Trindel Insurance Fund

103

0

100%

18

9

50%

SPNet Network

52

0

100%

16

4

75%

City of Anaheim (CA)

162

0

100%

14

5

64%

Sierra Pacific Industries

106

0

100%

13

7

46%

Alternative Service Concepts

100

0

100%

11

8

27%

Risico Claims Management, Inc.

95

0

100%

11

5

55%

Arrowpoint Capital

64

0

100%

10

5

50%

City of Sacramento (CA)

61

0

100%

10

5

50%

City of Compton (CA)

54

0

100%

10

5

50%

Ryder Services Corp

97

0

100%

8

6

25%

Great West Casualty Company

37

0

100%

8

3

63%

Harford Mutual Insurance Company

29

0

100%

8

3

63%

AccidentFund

97

0

100%

7

4

43%

City of San Jose (CA)

82

0

100%

6

2

67%

North American Risk Services

137

0

100%

5

1

80%

Golden State Risk Management Authority (CA)

57

0

100%

5

2

60%

Eberle Vivian

45

0

100%

5

5

0%

The Cincinnati Insurance Company

55

0

100%

4

3

25%

Warner Brothers

51

0

100%

4

2

50%

County of Shasta (CA)

17

0

100%

3

3

0%

Underwriters Safety and Claims

16

0

100%

2

1

50%

City of Pasadena (CA)

10

0

100%

2

2

0%

daisyBill has the technology and expertise to make workers’ comp work better. Reach out to see how we can help your practice obtain fast, correct reimbursement for treating injured workers.

LET’S TALK

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DaisyBill provides content as an insightful service to its readers and clients. It does not offer legal advice and cannot guarantee the accuracy or suitability of its content for a particular purpose.

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