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.

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.

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!  

Data: 277 ACK Non-Compliance

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.

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