Alert: 3,700+ e-Bills for 98 Claims Administrators Missing or Late 277 ACKs

Alert: 3,700+ e-Bills for 98 Claims Administrators Missing or Late 277 ACKs

Data Dimensions (formerly WorkCompEDI) is a clearinghouse which accepts and responds to providers’ electronic bills on claims administrators’ behalf. For nearly 100 claims administrators, Data Dimensions failed to compliantly respond to thousands of provider e-bills.

The California Division of Workers’ Compensation (DWC) requires the claims administrator, upon receipt of an e-bill, to either accept the e-bill as complete or reject the e-bill as incomplete. Within 2 working days of receiving an e-bill, the claims administrator (or its clearinghouse) must send the provider an electronic ‘277 Acknowledgment’ alerting the provider that either:  

  • The e-bill submission was received and accepted for processing by the claims administrator, or
  • The e-bill was rejected and will not be processed by the claims administrator.

As of this writing, Data Dimensions has failed to timely send 277 Acknowledgments (277 ACKs) for thousands of e-bills, on behalf of 98 different claims administrators.

On 5/10/2022, daisyBill contacted Data Dimensions to report this critical issue. Without the 277 Acknowledgment, providers cannot know whether their e-bill was accepted or rejected for processing.  As of 5/16/2022, this e-billing non-compliance remains unresolved.

The table below lists the claims administrators that are failing to adhere to California e-billing regulations, as well as the count of e-bills for which the required 277 Acknowledgment was late or is missing.

California Medical Billing and Payment Guide Section 7.1 requires a claims administrator to respond to a provider’s e-bill with a timely 277 acknowledgment. California law and regulators hold the claims administrator responsible for e-billing non-compliance, even if the failure lies with a clearinghouse, bill review, or other vendor. Per the DWC Electronic Medical Billing and Payment Companion Guide:

Billing agents, electronic billing agents, third party administrators, bill review companies, software vendors, data collection agents, and clearinghouses are examples of companies that may have a role in electronic billing. Entities or persons using agents are responsible for the acts or omissions of those agents executed in the performance of services for the entity or person. [emphasis added]

When a claims administrator fails to adhere to California e-billing requirements, daisyBill notifies our clients by appending a Non-Compliance Alert to the Bill History for each e-bill affected by the EDI error, as shown below.

5/16/2022

Details

Claims Administrator(s)

98 Claims Administrators - See list below

Clearinghouse

Data Dimensions

277 ACK Missing Count

1,957 (as of 5/16/2022)

277 ACK Late Count

1,768 (as of 5/16/2022)

In May, daisyBill discovered that 98 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

Claims Administrator

Non-compliant 277 ACKs

Sedgwick Claims Management Services

940

Tristar Risk Management

265

Keenan & Associates

223

Cannon Cochran Management Services Inc.

218

Athens Administrators

204

ESIS, Inc.

163

Adminsure, Inc.

146

LWP Claims Solutions

109

City of Los Angeles (CA)

80

Acclamation Insurance Management Services

77

Republic Indemnity

75

City of San Diego (CA)

71

CompWest Insurance Company

68

Los Angeles County Metropolitan Transit Authority (CA)

63

Farmers Insurance

61

Benchmark Insurance Company

57

Marriott Claims Service Corp

50

Markel First Comp Insurance

49

California Insurance Guarantee Association

49

Omaha National Group

46

Midwest Insurance

45

Homelink Network

40

CNA Insurance

40

Meadowbrook Insurance Group

29

Beta Healthcare Group Risk Management Authority

29

American Claims Management, Inc

29

Albertsons / Safeway / Vons

29

County of San Bernardino (CA)

28

County of Santa Clara (CA)

27

County of San Diego (CA)

25

Advantage Workers Compensation Insurance Company

25

Self-Insured Schools of California (CA)

23

Crum & Forster

21

Nassco / General Dynamics

16

Disneyland Resorts California

16

Tokio Marine Management

14

National Interstate Insurance

14

Intercare Holdings Insurance, Inc.

13

Charles Taylor TPA

13

Pegasus Risk Management Services

11

Nationwide Agribusiness Companies

10

Elite Claims Management

10

Creative Risk Solutions

10

American Equity Underwriters

9

United Heartland

8

Nationwide Insurance Companies

8

Contra Costa County Risk Management (CA)

8

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

8

Schools Insurance Authority (CA)

7

Redwood Empire Schools Insurance Group (CA)

7

Midwestern Insurance Alliance

7

Broadspire

7

Association of California Water Agencies JPIA

7

Cottingham & Butler Claim Services, Inc.

6

City of Riverside (CA)

6

Underwriters Safety and Claims

5

Sempra Energy Employee Care Services

5

Murphy and Beane

5

Municipal Pooling Authority (CA)

5

Contra Costa County Schools Insurance Group (CA)

5

City of Burbank (CA)

5

City and County of San Francisco (CA)

5

Amerisure

5

North Bay Schools Insurance Authority (CA)

4

Fresno Unified School District (CA)

4

Workers' Compensation Administrators, LLC

3

SPNet Network

3

National Casualty Company

3

Great West Casualty Company

3

Golden State Risk Management Authority (CA)

3

Constitution State Services

3

Brentwood Services Administrators, Inc.

3

Alternative Service Concepts

3

Sierra Pacific Industries

2

Ryder Services Corp

2

AccidentFund

2

Warner Brothers

1

Vanliner Insurance Company

1

Trindel Insurance Fund

1

The Cincinnati Insurance Company

1

The Black Car Fund

1

The Arizona School Alliance for Workers' Compensation, Inc.

1

Southern California Edison

1

Risico Claims Management, Inc.

1

Nordstrom Workers' Compensation

1

Loma Linda University (CA)

1

Harford Mutual Insurance Company

1

Garden Grove Unified School District (CA)

1

Eberle Vivian

1

City of Torrance (CA)

1

City of San Jose (CA)

1

City of Compton (CA)

1

City of Anaheim (CA)

1

Auto-Owners Insurance Company

1

Arrowpoint Capital

1

ArcBest

1

Applied Underwriters

1

ACCG - GSIWCF

1

Total

3,719


daisyBill fights the good fight on behalf of workers’ comp providers. Reach out to see how we can help your practice obtain fast, correct reimbursement for treating injured workers.

LET’S TALK

How did you like the article ?

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.