Providers billing Disneyland Resorts, be warned: your electronic bills might be erroneously rejected.

Recently, we reported on Disneyland Resorts’ switching its bill review vendor to Rising Medical Solutions. With the bill review switch, Disneyland also changed its clearinghouse vendor to WorkCompEDI (WCEDI). Unfortunately, since the bill review switch, Disneyland is incorrectly rejecting providers’ e-bills sent via the new WCEDI Payer ID.

In failing to properly accept e-bills, Disneyland is preventing providers from billing electronically. Unfortunately (for providers), California rarely imposes penalties (against payers) for such non-compliance.

Instead, California effectively allows claims administrators to simply ignore workers’ comp laws and regulations.

Disneyland Incorrect e-Bill Rejections

On behalf of our clients, daisyBill monitors all e-bill rejections sent by payers and their clearinghouses. Following the switch in bill review vendors, we noticed that Disneyland was incorrectly rejecting providers’ compliant e-bills.

After inquiries from daisyBill, WCEDI blamed Disneyland for the current breakdown in e-bill processing. A WCEDI representative explained that Disneyland’s e-billing errors occurred because “The payer [Disneyland Resorts] had some data missing or incomplete within the sent claim file for some claims.”

We can’t speculate as to which party is truly responsible for the e-billing breakdown: Disneyland Resorts or Rising Medical or WCEDI. But under all circumstances (no speculation required), the California Division of Workers’ Compensation (DWC) holds self-insured employers, like Disney, responsible for the compliance (or noncompliance) of its vendors:

“The DWC Audit and Enforcement Unit audits insurance companies, self-insured employers, and third-party administrators to ensure that they have met their obligations under the Labor Code and the California Code of Regulations under the direction of the Administrative Director of the Division of Workers’ Compensation.”

daisyBill providers, rest easy; for now, your bills are being sent to Disneyland via fax (despite the fact that accepting electronic bills is mandatory under California law since October 2012):

For non-daisyBill providers, we strongly recommend you investigate whether your e-bills to Disneyland are on file with this payer.

No Consequences, No Compliance

As the claims administrator, Disneyland Resorts is ultimately responsible for ensuring timely processing and payment of electronic bills. Whether that means sharing the data WCEDI needs, or hiring a different bill review, Disneyland must find a way to compliantly accept e-bills from providers.

As in the past, we’re compelled to point out that the penalty for provider non-compliance with electronic billing rules is forfeiture of payment. Yet, when payers (and the clearinghouses hired by payers) can’t get it together, providers are expected to simply hope reimbursement comes eventually.

Until Disneyland resolves the problem, we encourage providers to file Audit Complaints with the DWC for each incorrectly rejected bill. By doing so, you add your voice to the chorus demanding payer accountability and compliance with electronic billing rules.

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