Last time, we covered:
- what happens after providers hit "send" when transmitting electronic bills
- why e-bills get denied
This time we discuss what happens when e-bills actually get to claims administrators and how claims administrators respond. Again, we'll analogize the e-billing process to the emailing process in order to help explain e billing concepts.
SENT/ACCEPTED FOR REVIEW
If the automated system doesn’t detect any errors, it forwards your email. The intended recipient gets your message in their inbox and can read the message.
If the claims administrator confirms that the e-bill submission is complete and that the injured worker can be verified, they will move the e-bill forward to review. The claims administrator has 2 working days from e-bill submission to notify the bill submitter that they forwarded the e-bill (purple).
When the intended recipient receives your email, her or she reviews your message and responds back to you via email.
Within 15 working days of e-bill submission, the claims administrator reviews the e-bill, sends complete remittance advice electronically (green), and sends payment for all uncontested amounts (pink).
Note: We understand that some claims administrators respond to e-bills with paper EORs. In the world of email, that is strange, but acceptable. In e-billing, sending a paper EOR in response to an e-bill is a violation of e-billing regulations.