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News, data, & insights about workers' comp billing

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How Electronic Billing Works, Part II

April 28, 2014 by Catherine Montgomery

Last time, we covered:

  • What happens after providers hit "send" when transmitting electronic bills
  • Why electronic bills get denied

This time we discuss what happens when electronic bills actually get to claims administrators and how claims administrators respond. Again, we'll analogize the electronic billing process to the emailing process in order to help explain e billing concepts.

SENT/ACCEPTED FOR REVIEW

Email

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.

Electronic Billing

If the claims administrator confirms that the electronic bill submission is complete and that the injured worker can be verified, they will move the electronic bill forward to review.  The claims administrator has 2 working days from electronic bill submission to notify the bill submitter that they forwarded the electronic bill (purple).

ELECTRONIC RESPONSE

Email

When the intended recipient receives your email, her or she reviews your message and responds back to you via email.

Electronic Billing

Within 15 working days of electronic bill submission, the claims administrator reviews the electronic bill, sends complete remittance advice electronically (green), and sends payment for all uncontested amounts (pink).

Note: We understand that some claims administrators respond to electronic bills with paper EORs.  In the world of email, that is strange, but acceptable. In electronic billing, sending a paper EOR in response to an electronic bill is a violation of electronic billing regulations.

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