We have yet another tale of a payer flagrantly ignoring its duty to compliantly process provider bills for treatment of injured workers. This account of payer friction highlights the ongoing, everyday grinding-down that providers must go through to simply submit and receive reimbursement for workers’ comp bills.
Effective 10/23/2019, The Hanover Insurance Group changed the vendor it uses for medical bill processing duties to Medata (notice below). On behalf of its clients, DaisyBill contacted Hanover Insurance and its vendor to determine the correct routing for electronic bills. The answer: Hanover is NOT currently accepting electronic bills from providers, and has not been able to since its change of vendor almost a month ago.
As most readers know, claims administrators must compliantly accept electronic bills from providers and must also compliantly return electronic explanations of review (EORs) to providers. This is the LAW in California.
While claims administrators may engage vendors to assist with processing electronic bills, ultimately the claims administrator is responsible for complying with all rules and regulations. The state of California does not penalize the vendor for noncompliance, the state penalizes the claims administrator for breaching its duty.
At the bottom of this post is the detailed timeline of the vendor change, with call notes made by DaisyBill staff which document our attempts to determine how providers can electronically transmit bills to Hanover.
Hanover Disregards Law and Providers Scramble to Adjust
The timeline of Hanover’s vendor change reveals a frustrating disregard for the law requiring claims administrators to accept electronic bills. It is important to note that, prior to the switch in vendors, Hanover complied with California’s electronic billing regulations: Hanover electronically accepted bills from providers and electronically returned EORs to providers.
Once providers make the effort to switch to electronic billing, which is encouraged by the state for its transparency and efficiency, providers should not subsequently need to scramble to figure out how to send bills non-electronically. Providers cannot easily fall back on old dismantled mail systems, nor should they need to. Further, electronic billing offers invaluable proof of receipt by the claims administrator, which is critically important to preserve provider rights.
While some in the industry may assert that this Hanover tale represents a typical electronic “glitch,” this excuse is just not true (we know this from DaisyBill’s extensive experience and mountains of data). Worse, this excuse normalizes the payment burden experienced by providers. When did it become entirely normal and unremarkable that providers must overcome claims administrator obstacles and “glitches” to get paid?
Providers have no easy recourse in the face of claims administrator violation of the rules. In contrast, if a provider fails to timely submit a bill or an appeal for correct payment, the claims administrator simply denies the bill; no payment is due to the provider.
Hanover Hurts Workers’ Comp
Hanover is hurting workers’ comp by its indifference to the friction that results from its failure to accept electronic bills from providers--providers who treat the injured workers of employers insured by Hanover. To notify the state of this Hanover noncompliance, we will advise our 4,700+ clients to submit Audit Complaints* to the California Division of Workers’ Compensation (DWC) citing the Hanover breach of duty of California Labor Code 4603.4.
Every year DaisyBill processes millions of workers’ comp electronic bills. We work with all of the claims administrators and the many vendors that service these claims administrators. Our goal is simple: to reduce provider friction so more providers agree to treat injured workers. More providers are a win for both employers and injured workers.
Hanover Notice of New Vendor
DaisyBill Call Notes With Hanover
10/23/2019 (Vendor Transition Date)
Hanover claims rep indicated effective 10/23/2019 all bills should be submitted to Medata.
Hanover claims rep also verified that bills for Citizens Insurance and Hanover Lloyd's can be sent to the same mailing address. [Previous vendor’s electronic billing list] also indicates they should all go to Medata.
Hanover claims rep indicated there is no email or fax route available for bill submissions.
DaisyBill Call Notes With New Hanover Vendor
As of 10/24/2019, Medata does not have access to Hanover claims yet and there is no workflow in place to process bills. Bills can be submitted to the mailing address provided, but the bills will not be processed until Medata has access to Hanover claims. Since there is no workflow in place, rep advised not to email bills.
Medata anticipates they will have access in November, and advised to call back after 11/4/2019.
As of 11/5/2019, Medata still does not have access to Hanover claims. There is no workflow in place to process bills and the Medata rep was unable to provide information on what they're doing with bills that are mailed to them in the meantime.
Medata rep indicated there is no anticipated date for their software to be updated with access to Hanover claims.
As of 11/11/2019, Medata is in transition and has started receiving files from [previous vendor]. Medata is able to do a basic claim number search and successfully locate a patient, but bill information is inconsistent and may not be able to be located (used this bill as an example: 3XXXX2). Medata advised to check back on Friday, 11/15.
Per Medata rep JXXX, bills are only accepted by mail and there is not an email or fax number available.
As of 11/19/2019, Medata is still in transition. Medata is able to look up claims and successfully locate a patient as well as bill information for bills processed by [previous vendor]. However, denial reasons are not loaded into their software yet (used this bill as an example: 3XXXX8). Medata advised to check back next week.
Per Medata rep JXXX, bills are only accepted by mail and there is not an email or fax number available yet, but maybe in the future.
*NOTE: The Audit Complaint form was updated in 2019. Access the updated form here: https://www.dir.ca.gov/dwc/Auditref.pdf
DaisyBill is on your side. Our customer service and claims administrator follow-up are unmatched--see how we can make workers’ comp billing faster, more efficient, and more profitable for your practice.