Alert: ESIS Fails to Process e-Bills Due to (Their) Document Error

Alert: ESIS Fails to Process e-Bills Due to (Their) Document Error

A daisyBill provider client recently brought to our attention systemic e-billing non-compliance by Third-Party Administrator (TPA) ESIS, Inc. Specifically, ESIS denied payment due to a falsely alleged lack of supporting documentation for an e-bill submission.

On 5/3/2022 dasiyBill contacted ESIS’ clearinghouse, Data Dimensions, regarding ESIS’ improper denial. On 5/11/2022, Data Dimensions reported: "ESIS had an issue with their systems that caused the rejections and advised that the bills must be resent.” Data Dimensions is resubmitting these improperly processed bills to ESIS for payment.

Fortunately, e-billing protects providers from claims administrators falsely denying payment for “missing documentation.”

All e-bill submissions sent via daisyBill are transmitted with the supporting documentation uploaded by the provider. Electronically transmitting supporting documents with the e-bill instantly creates a verifiable record, unequivocally proving precisely which documents the provider sent with the e-bill.

With proper e-billing, documents cannot be “lost in the cloud.”

Alert: Providers who do not use daisyBill to submit e-bills to ESIS must review all e-bills for which ESIS denied payment for missing documentation. Where ESIS falsely denied payment for missing documentation, contact Data Dimensions to resubmit the e-bills to ESIS for proper processing.

Below is the alert added to every daisyBill e-bill impacted by the ESIS document error. This alert warns the client to report to daisyBill if, after resubmission, ESIS subsequently denies the e-bill.

In such cases, daisyBill will submit an Audit Complaint to the Division of Workers’ Compensation (DWC) for ESIS’s systemic failure to compliantly process e-bills.

Additionally, the Non-Compliance Alert below is appended to the Bill History for all affected daisyBill e-bills.

Details

Claims Administrator

ESIS, Inc.

Bill Review

ESIS MedBill Impact

Clearinghouse

Data Dimensions

e-Bill Misprocessed Count

144 (as of 5/18/2022)

Below see the action daisyBill is taking to resolve the EDI Error as noted above.

On 5/3/2022 daisyBill alerted Data Dimensions that ESIS failed to process e-bills due to a document error.

🌼 As of now, daisyBillers do not need to take any action regarding this EDI non-compliance. Report to daisyBill if ESIS subsequently denies the e-bill so that daisyBill may submit an Audit Complaint to the DWC. Have a Flower Power Day!

Date

Action

4/29/2022

daisyBiller reports ESIS failed to properly process e-bills.

5/3/2022

daisyBill reports EDI error to Data Dimensions, the designated clearinghouse for ESIS.

5/11/2022

Data Dimensions replies: “ESIS had an issue with their systems that caused the rejections and advised that the bills must be resent. Would you like to resend them, or would you like me to re-transmit?"

5/18/2022

daisyBill requests Data Dimensions resubmit the improperly processed bills.

5/18/2022

e-Bill Misprocessed Count: 144


daisyBill has the technology and expertise to make workers’ comp work better. Reach out to see how we can help your practice obtain fast, correct reimbursement for treating injured workers.

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