Warning: ESIS (Still) Ignoring CA Medical-Legal Bills

Warning: ESIS (Still) Ignoring CA Medical-Legal Bills

How else can we put this? Sometimes ESIS, a Third-Party Administrator (TPA), just flat-out ignores bills for Medical-Legal services.

Below, daisyBill documents how ESIS is in violation of California law (to say nothing of the basic principles of commerce generally) by failing to timely issue payment for ten Medical-Legal evaluations. daisyBill submitted formal Audit Complaints to the Division of Workers’ Compensation (DWC) reporting the ten unpaid bills.

Qualified Medical Evaluators (QMEs) and Agreed Medical Evaluators (AMEs), check your Accounts Receivables for unpaid ESIS bills. To receive payment for performing Medical-Legal evaluations, daisyBill experience indicates that providers must call (and call and call) to get the ESIS adjuster to release payment.

These are not disputes over liability or the amounts owed; it is simply a case of ESIS’ receiving bills…and admittedly doing nothing. Sometimes indefinitely.

We urge the DWC to demonstrate that there is a limit to the level of disregard for the law that California is willing to tolerate.

ESIS: Putting Evaluators in Impossible Positions

Per California Labor Code Section 4622, ESIS has 60 days from receipt of a bill for Medical-Legal services to send the EOR and payment to the physician — after which penalty and interest payments apply.

ESIS has exceeded that time limit by as many as 337 days, and at minimum 62 days, as of this writing.

The table below lists the details of ESIS’s violations. If the DWC (and CWCI) want to better understand the reasons that fewer physicians will serve as QMEs, they should peruse the absurd ‘Call Notes’ below to see the payment torture ESIS inflicts on evaluators.

DOS

Employer

Bill Submit Date

Payment Overdue (Days)

Balance Due

Call Notes

4/20/2022

ABM Industries

5/20/2022

83

$2,216.50

Per ESIS Medbill Impact, the bill was received on 5/24/2022 and processed on 6/1/2022. Payment is pending adjustor approval.

Called ESIS claims department for adjustor info and left VM with adjustor. Adjustor called back indicating payment will be issued in full. As of this writing, the provider has not received the payment.

2/15/2022

AAA Northern California, Nevada and Utah

3/2/2022

162

$650.00

Per ESIS Medbill Impact, the bill was received on 3/4/2022 and processed on 4/13/2022. Payment is pending adjustor approval.

Called ESIS claims department for adjustor info and left VM with adjustor. As of this writing, the provider has not received the payment.

3/3/2022

AAA Northern California, Nevada and Utah

4/6/2022

127

$1,316.25

Per ESIS Medbill Impact, the bill was received on 4/8/2022 and processed on 4/14/2022. Payment is pending adjustor approval.

Called ESIS claims department for adjustor info and left VM with adjustor. As of this writing, the provider has not received the payment.

5/9/2022

Constellation Brands, Inc.

5/26/2022

62

$2,921.75

Per ESIS Medbill Impact, the bill was received on 5/31/2022 and processed on 6/3/2022. Payment was approved on 7/27/2022. The provider received payment WITHOUT penalty or interest.

1/18/2022

Staffing Network

3/3/2022

161

$2,015.00

Per ESIS Medbill Impact, the bill was received on 3/4/2022 and processed on 5/3/2022. Payment is pending adjustor approval.

Called ESIS claims department for adjustor info and spoke with adjustor. Per adjustor, payment was withheld due to a missing pay code error. ESIS switched systems last year, which has been causing a lot of bills to be placed in incorrect queues. During the call the Adjustor reported manually changing the pay code to DMX for QME and released payment in full. As of this writing, the provider has not received the payment.

4/7/2022

Staffing Network

4/12/2022

121

$650.00

Per ESIS Medbill Impact, the bill was received on 4/14/2022 and processed on 5/3/2022. Payment is pending adjustor approval.

Called ESIS claims department for adjustor info and spoke with adjustor. Per adjustor, payment was withheld due to a missing pay code error. ESIS switched systems last year, which has been causing a lot of bills to be placed in incorrect queues. During the call the Adjustor reported manually changing the pay code to DMX for QME and released payment in full. As of this writing, the provider has not received the payment.

10/22/2021

Allied Universal

11/42021

280

$503.75

Per ESIS Medbill Impact, bill was received on 11/8/2021 and processed on 11/16/2021. Payment is pending adjustor approval.

Called ESIS claims department for adjustor info and left VM with adjustor. As of this writing, the provider has not received the payment.

1/12/2022

Allied Universal

2/16/2022

176

$2,015.00

Per ESIS Medbill Impact, bill was received on 2/18/2022 and processed on 3/3/2022. Payment is pending adjustor approval.

Called ESIS claims department for adjustor info and left VM with adjustor. As of this writing, the provider has not received the payment.

3/29/2022

Allied Universal

4/4/2022

129

$650.00

Per ESIS Medbill Impact, the bill was received on 4/6/2022 and processed on 4/12/2022. Payment is pending adjustor approval.

Called ESIS claims department for adjustor info and left VM with adjustor. As of this writing, the provider has not received the payment.

8/10/2021

ABM Industries, Inc.

9/8/2021

337

$2,216.50

Per ESIS Medbill Impact, the bill was received on 9/10/2021 and processed on 9/30/2021. Payment is pending adjustor approval.

Called ESIS claims department for adjustor info and left VM with adjustor. As of this writing, the provider has not received the payment.

ESIS’s brand of hyper-non-compliance creates particularly large problems for QMEs and AMEs, since they must somehow track down ESIS adjusters (good luck) to obtain payment for evaluations.

We have reached out to ESIS countless times regarding the bills in question. We have published article after article decrying ESIS’s pattern of ignoring bills, or otherwise failing to reimburse physicians as required.

ESIS’s behavior, at best, creates incredibly wasteful, time-consuming, needless disputes. At worst, it leaves providers unjustifiably unpaid for services rendered.

If there was ever a time for the DWC to make an example, ESIS is that example. While there are only a limited number of prescribed reasons under the law for QMEs to turn down a panel request, the DWC cannot expect QMEs and AMEs to continue to accept evaluations from ESIS when ESIS refuses to pay its bills.


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