Free Webinar Series: Part 1 of 8: Master the Basics, Tuesday Tuesday, September 11th, 2018 1-2PM PDT

Blog: Daisy News

News, data, & insights about workers' comp billing

header_illustration_blogDaisyBill

How e-Billing Works, Part I

April 24, 2014 by Catherine Montgomery

If you’ve ever sent an email, you already have a general understanding of how workers’ compensation e-billing works.  So we’re going to use what you already know about e-mail to help you understand workers compensation e-billing.

INSTANT SUBMISSION

Email

With email, you write your message, click ‘send’ in your email client, and your message is sent instantly.  You can’t make any changes or corrections, because your message is already on its way to the intended recipient.

e-Billing

In workers’ comp e billing, a bill submitter prepares the bill, clicks ‘submit’ in the computer software they’re using, and the e-bill is instantly submitted.  Just like an email, it can’t be changed or corrected because it’s already on its way to the claims administrator.

ACKNOWLEDGEMENT PROTOCOLS

Email Error Checking

Most emails make it to their intended recipient without any problems.  However, if you've ever received an automated message from a mailer daemon, you know that some messages don't get sent as planned.

When you receive this automated message, you know that something went wrong with your send.

The automated messages help you solve the problem.  Automated email responses explain what went wrong (red), utilize specific codes for errors (blue), and provide instructions for what needs to be done to resolve the issue (orange).

e-Billing Acknowledgement Protocols

In compliance with the California workers’ comp regulations for e-billing, a claims administrator (or their EDI Agent) is in charge of setting up a system to check e-bills for the following two errors:

  1. Incomplete e-bill submissions.
  2. e-Bill submissions where the injured worker is completely unidentifiable as the insured.

If either or these errors are detected, a claims administrator has 2 working days from submission to:

  • Send the bill submitter codes that specifically describe the error (i.e. A6).
  • Send the bill submitter codes that describe how to resolve the error (i.e. 629).
  • Reject the e-bill back to the bill submitter.

DaisyBill's system displays rejections as follows:

Just as emails rejected by a mailer daemon never make it to their intended recipient, e-bills rejected by a claims administrator are never forwarded to the adjustor for review.  As far as the intended adjustor is concerned, rejected e-bills don’t exist.

The next post will cover what happens when e-bills actually get to claims administrators.

Search results for:

About Us

DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

Drop us a line with any news you would like us to share or any issue that concerns you.

intercom_chat_bubble_icon