e-EOR: Most Compliant Claims Admins 2023
Last week, we called out the 39 claims administrators that failed to adhere to California’s electronic Explanation of Review (e-EOR) requirement in 2023 so far. These claims administrators’ compliance with this critical mandate ranged from mediocre to abysmal, burdening providers with unnecessary, time-consuming manual work.
Today, we share the good news.
According to data from daisyBill providers, the 51 claims administrators listed below are remarkably compliant in sending e-EORs in response to electronic bills, as California law requires.
The total number of claims administrators on our “nice” list significantly exceeds last week’s “naughty” list — proving that with good technology and good-faith compliance, e-billing makes workers’ comp work smoothly for all stakeholders.
CA e-EOR Requirement
It’s a super-simple rule (especially by California workers’ comp standards): when a provider sends an e-bill for treating an injured worker, California regulations require the claims administrator to respond with an e-EOR detailing the payment details for the treatment.
As we’ve often explained, e-EORs automatically post payment information to the e-bill in the provider’s system and instantly confirm the payment's timeliness (or not). This automatic posting saves huge administrative costs by eliminating the need for a practice’s administrative staff to post payment details manually.
A claims administrator’s non-compliance with the e-EOR requirements defeats the benefits of e-billing for a provider by wasting immeasurable practice time and resources.
The tables below reflect e-EORs sent in response to e-bills submitted by daisyBill providers from January 1, 2023 to May 31, 2023. Every claims administrator listed complied with the e-EOR requirement at least 95% of the time. Kudos!
Best of the Best: Most Compliant Claims Admins
The 14 claims administrators listed below responded with e-EORs for at least 99% of the e-bills submitted by daisyBill providers in the first five months of 2023.
This list of the BEST proves that both small and large claims administrators can comply with Division of Workers’ Compensation (DWC) regulations requiring e-EORs in response to e-Bills.
Claims Administrator |
Submission Total |
e-EOR Missing Total |
e-EOR Missing % Total |
2023-01 |
2023-02 |
2023-03 |
2023-04 |
2023-05 |
Sentry Insurance |
5,753 |
3 |
0% |
0% |
0% |
0% |
0% |
0% |
City and County of San Francisco (CA) |
2,917 |
3 |
0% |
0% |
0% |
0% |
0% |
0% |
Albertsons / Safeway / Vons |
1,483 |
3 |
0% |
0% |
0% |
0% |
0% |
|
Beta Healthcare Group RMA |
1,956 |
5 |
0% |
0% |
1% |
0% |
0% |
1% |
American Equity Underwriters |
546 |
3 |
1% |
2% |
1% |
0% |
0% |
0% |
Benchmark Insurance Company |
3,124 |
29 |
1% |
1% |
0% |
1% |
1% |
2% |
Intercare Holdings Insurance Services, Inc. |
29,022 |
298 |
1% |
0% |
1% |
1% |
1% |
2% |
Next Level Administrators |
5,930 |
58 |
1% |
0% |
0% |
1% |
3% |
1% |
Republic Indemnity |
4,689 |
46 |
1% |
0% |
0% |
0% |
0% |
4% |
Elite Claims Management, Inc. |
1,427 |
14 |
1% |
1% |
0% |
2% |
2% |
0% |
Alaska National Insurance |
2,636 |
29 |
1% |
0% |
0% |
5% |
0% |
0% |
Nassco / General Dynamics |
1,156 |
13 |
1% |
0% |
0% |
0% |
0% |
4% |
City of Los Angeles (CA) |
3,367 |
40 |
1% |
1% |
1% |
1% |
1% |
2% |
Pacific Gas & Electric |
821 |
11 |
1% |
1% |
0% |
2% |
1% |
2% |
Totals |
64,827 |
555 |
e-EOR (Excellent) Compliance January - May 2023
The claims administrators below are listed in descending order of the number of e-bills submitted by daisyBillers. These insurers, employers, and Third-Party Administrators (TPAs) varied in their compliance rates, but all kept the non-compliance under 5%.
The best part? 51 claims administrators made the list below, while only 39 met the criteria for last week’s shame-posting. In other words, more claims administrators are doing the right thing (adhering to DWC regulations) than the wrong thing (ignoring DWC regulations) — even if it takes some occasional prodding from scrappy e-billing bloggers.
Claims Administrator |
Submission Total |
e-EOR Missing Total |
e-EOR Missing % Total |
2023-01 |
2023-02 |
2023-03 |
2023-04 |
2023-05 |
State Compensation Insurance Fund (CA) |
45,597 |
1,000 |
2% |
0% |
0% |
2% |
0% |
8% |
Gallagher Bassett Services Inc. |
41,631 |
1,035 |
3% |
2% |
3% |
3% |
3% |
2% |
Intercare Holdings Insurance Services, Inc. |
29,022 |
298 |
1% |
0% |
1% |
1% |
1% |
2% |
Zurich Insurance North America |
21,669 |
930 |
4% |
1% |
2% |
2% |
3% |
13% |
AmTrust North America, Inc. |
17,502 |
600 |
3% |
3% |
3% |
4% |
3% |
4% |
Travelers |
17,289 |
593 |
3% |
4% |
9% |
3% |
2% |
2% |
Athens Administrators |
15,700 |
493 |
3% |
3% |
3% |
3% |
3% |
5% |
Insurance Company of the West |
12,437 |
300 |
2% |
2% |
2% |
1% |
3% |
4% |
Department of Labor |
8,492 |
299 |
4% |
5% |
5% |
3% |
3% |
3% |
Adminsure, Inc. |
7,470 |
301 |
4% |
8% |
4% |
2% |
3% |
3% |
The Zenith |
6,632 |
102 |
2% |
0% |
0% |
0% |
0% |
6% |
Next Level Administrators |
5,930 |
58 |
1% |
0% |
0% |
1% |
3% |
1% |
Sentry Insurance |
5,753 |
3 |
0% |
0% |
0% |
0% |
0% |
0% |
LWP Claims Solutions, Inc. |
5,637 |
162 |
3% |
4% |
3% |
2% |
3% |
3% |
Pacific Compensation Insurance Company |
4,727 |
152 |
3% |
2% |
4% |
4% |
3% |
2% |
Republic Indemnity |
4,689 |
46 |
1% |
0% |
0% |
0% |
0% |
4% |
Acclamation Insurance Management Services |
4,083 |
86 |
2% |
0% |
0% |
4% |
0% |
5% |
City of Los Angeles (CA) |
3,367 |
40 |
1% |
1% |
1% |
1% |
1% |
2% |
City of San Diego (CA) |
3,247 |
62 |
2% |
0% |
1% |
3% |
3% |
2% |
Benchmark Insurance Company |
3,124 |
29 |
0% |
1% |
0% |
1% |
1% |
2% |
Farmers Insurance |
2,980 |
44 |
2% |
2% |
2% |
2% |
2% |
0% |
City and County of San Francisco (CA) |
2,917 |
3 |
0% |
0% |
0% |
0% |
0% |
0% |
Alaska National Insurance |
2,636 |
29 |
1% |
0% |
0% |
5% |
0% |
0% |
CNA Insurance |
2,460 |
54 |
2% |
6% |
2% |
1% |
1% |
2% |
County of Santa Clara (CA) |
2,005 |
58 |
3% |
2% |
2% |
3% |
4% |
4% |
Beta Healthcare Group Risk Management Authority |
1,956 |
5 |
0% |
0% |
1% |
0% |
0% |
1% |
County of San Diego (CA) |
1,676 |
27 |
2% |
2% |
2% |
1% |
3% |
1% |
Albertsons / Safeway / Vons |
1,483 |
3 |
0% |
0% |
0% |
0% |
0% |
|
Elite Claims Management, Inc. |
1,427 |
14 |
1% |
1% |
0% |
2% |
2% |
0% |
Innovative Claim Solutions |
1,161 |
17 |
2% |
1% |
1% |
0% |
0% |
5% |
Nassco / General Dynamics |
1,156 |
13 |
1% |
0% |
0% |
0% |
0% |
4% |
Self-Insured Schools of California (CA) |
1,107 |
32 |
3% |
12% |
3% |
1% |
0% |
0% |
Markel First Comp Insurance |
1,074 |
25 |
2% |
1% |
4% |
1% |
4% |
2% |
Sutter Health |
1,058 |
29 |
3% |
7% |
1% |
3% |
1% |
3% |
City of Los Angeles Department of Water and Power (CA) |
1,022 |
44 |
4% |
5% |
1% |
2% |
3% |
9% |
County of Riverside (CA) |
919 |
31 |
3% |
0% |
1% |
4% |
4% |
8% |
Risico Claims Management, Inc. |
877 |
30 |
3% |
3% |
2% |
10% |
1% |
1% |
Charles Taylor, TPA |
842 |
30 |
4% |
6% |
1% |
2% |
5% |
5% |
Pacific Gas & Electric |
821 |
11 |
1% |
1% |
0% |
2% |
1% |
2% |
GuideOne Insurance |
815 |
35 |
4% |
1% |
2% |
5% |
1% |
11% |
CopperPoint Mutual |
784 |
14 |
2% |
4% |
0% |
1% |
2% |
2% |
WCF Insurance |
739 |
25 |
3% |
0% |
1% |
2% |
2% |
10% |
Berkley Net Underwriters, LLC |
724 |
31 |
4% |
0% |
1% |
1% |
1% |
17% |
Nationwide Insurance Companies |
705 |
19 |
3% |
3% |
1% |
1% |
6% |
2% |
Contra Costa County Schools Insurance Group (CA) |
698 |
16 |
2% |
0% |
0% |
2% |
0% |
8% |
Workers' Compensation Administrators, LLC |
624 |
24 |
4% |
3% |
8% |
2% |
3% |
5% |
American Equity Underwriters |
546 |
3 |
1% |
2% |
1% |
0% |
0% |
0% |
Mitsui Sumitomo Marine Management (U.S.A), Inc. |
499 |
19 |
4% |
0% |
4% |
11% |
2% |
0% |
National Liability and Fire Insurance Company |
475 |
19 |
4% |
5% |
4% |
2% |
6% |
4% |
Disneyland Resorts California |
466 |
20 |
4% |
2% |
12% |
5% |
1% |
3% |
Pegasus Risk Management, Inc. |
441 |
13 |
3% |
0% |
10% |
3% |
2% |
0% |
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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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