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How e-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 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

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.

e-Billing

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).

ELECTRONIC RESPONSE

Email

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

e-Billing

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.

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