How to e-Bill: Clearinghouse/Payer IDs Are Key to Quick Payment

How to e-Bill: Clearinghouse/Payer IDs Are Key to Quick Payment

Regularly, we hear from providers (who are not daisyBill clients) reporting that electronic billing simply does not work. However, daisyBill data —  from our millions of quickly-paid e-bills — proves that e-billing works beautifully when done right.

What causes e-billing to fail for some providers and not others? The answer comes down to using the correct e-billing “address” when sending e-bills to the payer.

For successful workers’ comp e-billing, providers must send e-bills to the correct e-billing address assigned to each payer. But determining the correct e-billing address is tricky, because an e-billing address consists of two important components:

  1. The clearinghouse employed by the payer, and
  2. The Payer ID number assigned by the clearinghouse to the payer

For payment, a provider must send the e-bill to the clearinghouse hired by the payer, using the correct Payer ID assigned to the payer by the clearinghouse. This Clearinghouse/Payer ID combination is the e-billing address, and the key to successfully transmitting a workers’ comp e-bill.

Without fail, non-client providers (who assert e-bills don’t work) send e-bills to the wrong e-billing address, which (logically) results in failure to obtain payment. Inevitably, these non-client providers send all of their workers’ comp e-bills to a single clearinghouse, often not even a workers’ comp clearinghouse. And of course, these providers have little concept as to the Payer IDs being used to send their e-bills.  

Bottom line: Sending an e-bill to the wrong clearinghouse or with the wrong Payer ID results (predictably) in failed e-billing and no payment. Provider alert: Frequently, revenue cycle management (RCM) software and clearinghouses claim to correctly reroute your e-bills to the correct clearinghouse with the correct Payer ID. These claims are 100% false (As proven by the simple fact that the e-bills remain unpaid).

To help other e-billing providers, below we demonstrate exactly how daisyBill e-billing software sends e-bills to the correct clearinghouse, using the correct Payer ID number. Additionally, we share daisyBill average days to payment as proof that e-bills work when sent to the correct clearinghouse/Payer ID electronic address.

837s: How To Send Compliant Workers’ Comp e-Bills

Workers’ comp providers must transmit e-bills in the required ANSI X12 837 EDI standard electronic format — called an ‘X12 837’ for short. E-billing software essentially “translates” the data providers would furnish on a paper billing form (like the CMS-1500) into data transmitted in an 837 file.

Creating the e-bill is only half the job, however.

Once the 837 file is ready, the e-billing software must transmit the 837 data to the correct clearinghouse using the correct Payer ID assigned to the payer. This is where workers’ comp e-billing gets tricky.

Payer ID Numbers Explained: Transmitting 837 e-Bill Data

Fact: Most workers’ comp payers/claims administrators (including insurers, third-party administrators (TPAs), and self-insured employers) lack the necessary technology to accept e-bills in 837 format. 

For that reason, these payers employ clearinghouses to accept provider e-bills on the payer’s behalf. Currently, workers’ comp payers mainly employ one of the following three clearinghouses:

  1. Jopari
  2. Data Dimension (formerly WorkCompEDI)
  3. Carisk

This clearinghouse chosen by the payer assigns the payer a specific Payer ID number. To properly send an e-bill, the provider must send e-bills to the clearinghouse chosen by the payer, and use the correct Payer ID (the ID assigned to the payer by the clearinghouse).

Sending e-bills to the wrong clearinghouse or sending e-bills with the wrong Payer ID (or both) results in unpaid e-bills that are “not on file.” But when providers e-bill correctly, the results are undeniable.

Data: How Correct e-Billing = Fast Payment

Below is a table of the top 20 claims administrators (aka: payers) to which daisyBill sends e-bills on behalf of our provider clients, listed in order of the volume of e-bills our clients send to each.

Note that two of the claims administrators below do not use a clearinghouse, as each maintains the necessary technology to accept provider e-bills on their own (without a clearinghouse):

  1. CorVel
  2. The US Department of Labor

Most importantly, notice the extremely low average days to pay for each payer. When e-bills are sent to the correct e-billing address with the correct Clearinghouse/Payer ID, e-bills are usually paid timely.

Claims Administrator

Clearinghouse

Payer ID(s)

2021 daisyBill

Bill Count

Average Days To Pay

Sedgwick Claims Management Services - TPA

Data Dimensions

Main Payer ID: WX867

Client-Specific Payer ID Count: 9

386,015

11

Gallagher Bassett

Jopari

TP057

135,991

8

State Compensation Insurance Fund (CA)

Jopari

35076

132,794

13

Liberty Mutual Insurance

Jopari

33600

71,128

8

Zurich Insurance North America

Jopari

16535

64,600

9

Berkshire Hathaway Homestate Companies

Carisk

E0679

56,441

12

Broadspire - TPA

Carisk

Main Payer ID: E8088

Client-Specific Payer ID Count: 4

54,612

9

ESIS Inc. - TPA

Data Dimensions

Main Payer ID : CQ200

Client-Specific Payer ID Count: 1

54,353

13

CorVel - TPA

None

Main Payer ID: None

Client-Specific Payer ID Count: 409*

50,704

8

Tristar Risk Management - TPA

Jopari

Main Payer ID: 41556

49,426

12

AmTrust North America

Availity

12491

44,129

19

Intercare Holdings Insurance, Inc. - TPA

Data Dimensions

Main Payer ID: WB422

Client-Specific Payer ID Count: 6

41,356

9

Cannon Cochran Management Services Inc. - TPA

Data Dimensions

WR322

38,807

18

Athens Administrators - TPA

Data Dimensions

Client-Specific Payer IDs: 139

37,112

13

Insurance Company of the West

Jopari

27847

33,391

8

Department of Labor

None

77044

27,009

10

Keenan & Associates - TPA

Data Dimensions

Main Payer ID: WZ439

Client-Specific Payer ID Count: 1

21,684

10

The Zenith

Jopari

13269

19,991

9

AIMS - TPA

Data Dimensions

Client-Specific Payer IDs: 38

19,086

12

Adminsure - TPA

Data Dimensions

Main Payer ID: CB145

Client-Specific Payer ID Count: 6

18,538

8

Important Payer ID  Notes

  1. For internal purposes, TPAs often assign ‘client-specific Payer IDs.’ The TPA assigns a single self-insured client its own Payer ID that a provider must use when sending an e-bill for that self-insured client.

    This “boutique” e-bill routing complicates matters for e-billing providers, because the provider must know the specific payer ID for the underlying self-insured employer. This requires specialized workers’ comp e-billing technology.

  1. CorVel maintains 409 Payer IDs, because this TPA acts as its own clearinghouse and assigns a different Payer ID number to each CorVel payer-client. e-billing requires the provider to use the correct Payer ID CorVel assigns to each of its clients (and yes, this also requires specialized workers’ comp e-billing technology).

  1. Athens Administrators and AIMS both use a clearinghouse to accept e-bills from providers. These two TPAs do not maintain a Main Payer ID. Instead, both assign a different Payer ID number to each payer-client.

    Both claims administrators require a provider to send a paper bill if there is no client-specific Payer ID assigned to the payer-client
    (this is theoretically disallowed in California, but welcome to California workers’ comp, where regulators routinely ignore payer noncompliance).

e-Billing Works With Correct Clearinghouse/Payer ID

No doubt, workers’ compensation e-billing is more complicated than Medicare or group health e-billing. No doubt, daisyBill data proves e-billing works when e-bills are properly routed to the correct electronic address (i.e. the correct Clearinghouse/Payer ID combination).

So how does daisyBill consistently, properly route each e-bill? We maintain a back-end database of every e-billing address for every claims administrator, including when the claims administrator maintains multiple Payer IDs.

With the appropriate claims administrator selected, daisyBill providers simply enter the information that would normally go onto a paper billing form. daisyBill then converts that information (and supporting documents) into the required electronic formats, and securely transmits it all via the correct clearinghouse, and correct Payer ID electronic address.

In this way, daisyBill lifts the burden of keeping track of this information from providers, and ensures that every e-bill reaches its destination.


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