For providers treating injured workers, knowing where to send your workers’ comp bills is never simple, and involves multiple entities with constantly shifting relationships.

The claims administrator is the entity responsible for ensuring that providers receive payment for an injured worker’s care. Accordingly, the claims administrator is always the entity to which the provider must send their bills.

Complicating matters, the claims administrator may be the employer’s workers’ comp insurer (e.g., Liberty Mutual) a public or private self-insured employer (e.g., municipal governments or companies like Marriott), or a Third-Party Administrator (TPA) that administers injury claims on behalf of the insurer or self-insured employer (e.g., Sedgwick).

Finally, for electronic billing (e-billing), most claims administrators hire a clearinghouse to accept e-bills from providers. These entities accept and respond to e-bills on behalf of claims administrators that lack the ability to do so for themselves.

Providers must track claims administrators and the clearinghouses they utilize to ensure they send bills to the right place. That’s why daisyNews regularly publicizes changes to:

• Which claims administrators handle workers’ comp medical bills for each employer
• Which clearinghouses claims administrators use to facilitate electronic billing (e-billing)

Review the table below for the latest clearinghouse updates to ensure your practice receives reimbursement quickly and with minimal hiccups.

Electronic Billing Clearinghouse Updates

For the table below, the ‘New Clearinghouse’ accepts and responds to e-bills on behalf of the ‘Claims Administrator’ as of the ‘Effective Date.’

We list the ‘Previous Clearinghouse’ for reference, but they no longer accept providers’ e-bills on behalf of the Claims Administrator.

Clearinghouses: e-Billing Facilitators

Most claims administrators lack the technological ability and expertise to receive and respond to providers' electronic bills (e-bills). That’s where clearinghouses come in.

A clearinghouse is a vendor that:

• Receives e-bills from providers on the claims administrator's behalf
• Returns electronic acknowledgments confirming that they received the e-bill
• Transmits electronic Explanations of Review (e-EORs) with payment details to the provider

Most claims administrators must use a clearinghouse to accept e-bills. Exceptions include CorVel, a TPA, and the federal Department of Labor (DOL). Both of these claims administrators can accept and respond to e-bills on their own.

How daisyBill Makes Billing Easier

Correctly routing e-bills to claims administrators (through the appropriate clearinghouses where applicable) can be a logistical nightmare, so we built a network of e-billing routes to ensure our providers' bills have a smooth journey.

• daisyBill connects directly with all major clearinghouses; our software routes each bill to the correct clearinghouse the claims administrator designates.
• daisyBill directly transmits e-bills to claims administrators that do not use a clearinghouse (like CorVel and the DOL).

This direct e-bill routing eliminates the logistical challenges that lead to e-bills getting “lost” or ending up “not on file.” The result: claims administrators pay our providers in 9.1 days on average.

In a future article, we’ll update readers on changes to which claims administrators handle claims for various employers. Subscribe to daisyNews for ongoing updates and workers’ comp billing best practices.

Make workers’ comp easy. Schedule a chat with our team to see how daisyBill can take the hassle out of billing and payment.

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