LWP Refuses to Pay e-Bills, Forcing CA Doctors to Fax Bills

August 18, 2022 9 min read

By: the daisyNews Team

LWP Refuses to Pay e-Bills, Forcing CA Doctors to Fax Bills

California workers’ comp law has precise, mandatory requirements for electronic bill submission by providers, and precise, mandatory requirements for how payers must respond to those e-bills. Yet too often, providers (or in this example, providers’ e-billing agents) must go to extraordinary lengths to get payers to comply with the law — something state legislators and regulators should be doing, not doctors or e-billing software companies.

For example, brutal exchanges between daisyBill and LWP Claims Solutions demonstrate how providers must devote indefensible amounts of time, effort, and administrative resources to convince, cajole, and coerce claims administrators to simply do what the law says.

Because LWP delays and withholds payment from doctors via its e-billing noncompliance, daisyBill has resorted to faxing thousands of paper bills to LWP, just to get our clients reimbursed properly. On those clients’ behalf, daisyBill also filed 7,112 Audit Complaints with the Division of Workers’ Compensation (DWC) to report LWP’s e-billing failures.

But what happens to providers who don’t have a scrappy e-billing agent in their corner? California legislators and regulators are failing these providers.

Providers should not have to go through the torment described below to receive payment as mandated. Nor should providers have to employ a team of e-billing experts to chase claims administrators around — as happy as we are to hold payers accountable on behalf of all workers’ comp providers, clients and non-clients alike.

LWP: Wasting Provider Time & Resources

As we explained in this article, LWP has found just about every possible way to fail at e-billing. From improperly rejecting valid e-bills in varied, impermissible ways, to sending bogus Explanations of Review (when they bother to send them at all), to discovering whole new methods of non-compliantly denying payment. LWP can’t see a rake without stepping on it.

It may surprise regular readers to learn that prior to involving the DWC or even blog-shaming LWP into an appropriate level of embarrassment, we first reached out to seek solutions. Over a period of months, we made the failures exceedingly clear to LWP and asked (before ultimately insisting) LWP do its job.

Sadly — but emblematically for California workers’ comp — LWP and its clearinghouse, Data Dimensions, rewarded our sincere efforts not with solutions, but with delays, non-answers, blame-shifting, and still-unfulfilled and false compliance pledges.

Some of the most unhelpful quotes from LWP include:

“It has been a whirlwind trying to determine what exactly has gone wrong…”

“There were a number of non-compensable claims that were turned away at the portal…We will pursue this until we can resolve any remaining processing issues.”

“...we are working very hard at fixing these issues…it has our entire management team's attention…I hope to be able to report significant progress on this shortly -- We…hope to have a fix in place in the very near term.”

“My sincere apologies…we have tried to work through this issue. As you can imagine it involves the coordination of a number of parties and we are pushing very hard to get this corrected.”

“...our goal is to be 100% compliant as quickly as we can.”

“We did find the issue here and we think it was corrected. [Data Dimensions] made an error…”

Polite? Yes. Contrite? Definitely. But none of that pays doctors timely or in accordance with the law.

daisyBill Outreach to LWP/Data Dimensions

The table below documents months of exchanges between daisyBill representatives and representatives of both LWP and Data Dimensions. These exchanges were entirely cordial. They were also time-consuming, human-resource-draining, and represent tangible, significant expense on our part.

Worst of all, not every provider has unabashed e-billing nerds to advocate for them in this way. Are these un-advocated-for providers paid promptly and accurately by LWP? When LWP fails to meet its obligations, how can these providers pursue what they’re owed without putting a serious strain on their practices?

California legislators and regulators, read the table below in its entirety, and ask yourself: is California the kind of regulatory environment that encourages providers to treat injured workers, or the kind that perfectly explains why injured workers have so much trouble finding care when they need it?

(PS - As of today, LWPs clearinghouse, Data Dimensions, continues to reject providers’ e-bills with a 277 ACK falsely stating: Claim Not Found.)

Date	e-Billing Issue	Actions, Notes & Results
5/18/2022	277 ACK Rejection Incorrect \| 835 Missing	daisyBill alerts LWP Claims Solutions Chief Information Officer that LWP is failing to comply with California EDI regulations by: 1. Sending incorrect 277 ACK rejections, and 2. Failing to send electronic EORs in the X12 835 format
5/18/2022	277 ACK Rejection Incorrect \| 835 Missing	daisyBill reports LWP EDI non-compliance and provides examples to Data Dimensions, the designated clearinghouse for LWP.
5/18/2022	277 ACK Rejection Incorrect \| 835 Missing	Data Dimensions replies to daisyBill: “Thanks for bringing this item to our attention. At this time, we have engaged with LWP for immediate resolution. These bills are rejecting on our front-end edits for claim matching. We are corresponding with LWP to help resolve this item and I will be in touch shortly with an update. In terms of the bills that have failed at the payer, we have compiled that list for review by LWP. ”
5/19/2022	277 ACK Rejection Incorrect \| 835 Missing	LWP replies to daisyBill that LWP is working with Data Dimensions to address the EDI non-compliance. “There were a number of non-compensable claims that were turned away at the portal -- these will be formally objected to in the future and the objection returned via EDI…We will pursue this until we can resolve any remaining processing issues.”
5/20/2022	277 ACK Rejection Incorrect \| 835 Missing	daisyBill alerts LWP that 100% of the LWP rejected e-bills were non-compliant because: 1. The 277 ACK Reject was received after the provider received a 277 ACK Accept, and all of the 277 ACK Rejects were received after the due date for the 277 ACK 2. The 277 ACK is not intended to be an adjudication or an Explanation of Review (EOR)
6/2/2022	277 ACK Rejection Incorrect \| 835 Missing	daisyBill alerts LWP that LWP remains non-compliant with California e-billing laws and regulations: 1. LWP continues to non-compliantly reject e-bills 2. LWP continues to fail to timely send electronic EORs
6/2/2022	277 ACK Rejection Incorrect \| 835 Missing	LWP replies “...we are working very hard at fixing these issues - I can tell you that it has our entire management team's attention…I hope to be able to report significant progress on this shortly -- We had identified the 835 issue and hope to have a fix in place in the very near term.” LWP CIO cc’ed: LWP President and CEO LWP Chief Financial Officer LWP Vice President, Claims
6/2/2022	277 ACK Rejection Incorrect \| 835 Missing	daisyBill requests LWP provide an estimated date of when LWP intends to comply with California law and regulations.
6/8/2022	277 ACK Rejection Incorrect	Data Dimensions provides daisyBill with a list of comments for the LWP rejected bills. The comments fail to explain the non-compliant rejections.
6/9/2022	277 ACK Rejection Incorrect	daisyBill asks Data Dimensions for additional clarification.
6/15/2022	835 Missing	daisyBill alerts LWP that LWP continues to be 835 non-compliant, leaving daisyBill with no choice but to report LWP to the DWC Audit Unit.
6/15/2022	277 ACK Rejection Incorrect \| 835 Missing	LWP replies: “My sincere apologies for failing to respond as we have tried to work through this issue. As you can imagine it involves the coordination of a number of parties and we are pushing very hard to get this corrected. Our understanding is that Data Dimensions has received a large amount of 835 responses from our bill review provider and has been able to push those through. We are working on a significant change in work flow on a group of bills that we feel require an 835 and we have been sending a 277. That is requiring programing and coordination that is currently a top priority in our organization. We do understand the importance of correctly managing the ebill system and our goal is to be 100% compliant as quickly as we can. We will continue to keep you in the loop as progress is made.”
6/15/2022	277 ACK Rejection Incorrect \| 835 Missing	daisyBill requests LWP again provide an estimated date of when LWP intends to comply with California law and regulations.
6/15/2022	277 ACK Rejection Incorrect \| 835 Missing	LWP replies to daisyBill: “It has been a whirlwind trying to determine what exactly has gone wrong and what we need to do to correct is. We are still pushing for more definitive reporting and information from both Data Dimensions and our bill review provider. We hope to be fulling compliant with bills going forward no later than 8/1, based on programming needs and the coordination between all the parties. We will keep you up do date on our efforts and progress.”
6/21/2022	277 ACK Rejection Incorrect	Data Dimensions follows up with LWP regarding rejection comments clarification.
6/30/2022	277 ACK Rejection Incorrect	Data Dimensions replies to daisyBill: “This information is proprietary for LWP so I was unable to obtain additional detail.”
7/1/2022	835 Missing	LWP CFO replies to daisyBill: “We have worked with both accūrō and Data Dimensions and understand many missing 835s have been submitted and an issue that was causing errors there should be fully cleared up. We are definitely still working through issues on the list that have come to our attention but we wanted to follow up with you and verify that you are now seeing an influx of 835 reports that are correctly processing. We are still anticipating full compliance by 8/1. Would you be able to confirm the status as we continue our push to come into full compliance on these matters?”
7/1/2022	835 Missing	daisyBill alerts LWP that the LWP 835s are filled with data errors and completely unusable: wrong payees with wrong information and wrong payment amounts.
7/8/2022	277 ACK Rejection Incorrect	daisyBill data indicates the volume of LWP incorrect 277 ACK rejections has increased.
7/8/2022	277 ACK Rejection Incorrect	daisyBill reports 277 ACK rejection error to Data Dimensions.
7/13/2022	277 ACK Rejection Incorrect	Data Dimensions replies to daisyBill that a claims feed issue caused the incorrect 277 ACK rejections and that the issue has been resolved.
7/13/2022	277 ACK Rejection Incorrect	daisyBill resubmits incorrectly rejected e-bills.
7/15/2022	835 Missing	LWP CFO replies to daisyBill: “We did find the issue here and we think it was corrected. DD [Data Dimensions] made an error in consolidating what they thought was one check and it was actually two. We have not attempted to send corrected 835s but can do that if that would be appropriate. Do you have examples of other issues you are seeing that may need our immediate attention? Our goal is to become compliant and we want to make sure we are moving in the right direction from all perspectives.”
7/27/2022	277 ACK Rejection Incorrect	LWP continues to incorrectly reject e-bills.
7/27/2022	277 ACK Rejection Incorrect	daisyBill reports 277 ACK rejection error to Data Dimensions and requests a resolution date.
8/1/2022	277 ACK Rejection Incorrect	daisyBill follows up with Data Dimensions after no response was received.
8/2/2022	277 ACK Rejection Incorrect	Data Dimensions advises daisyBill that the claims feed issue was previously resolved.
8/3/2022	277 ACK Rejection Incorrect	daisyBill provides Data Dimensions with a recently rejected e-bill and an example of a prior bill for the same patient and injury that was accepted and paid, along with a paper Explanation of Review (EOR). daisyBill alerts Data Dimensions that the rejection volume has increased significantly.
8/5/2022	277 ACK Rejection Incorrect	Data Dimensions advises daisyBill that the issue was identified and a fix will be released over the weekend.
8/9/2022	277 ACK Rejection Incorrect	daisyBill asks Data Dimensions if the fix has been released.
8/9/2022	277 ACK Rejection Incorrect	Data Dimensions confirms the fix was released the prior evening.
8/10/2022	277 ACK Rejection Incorrect	daisyBill resubmits incorrectly rejected e-bills.
8/18/2022	835 Missing	LWP continues to fail to send 835s.
8/18/2022	277 ACK Rejection Incorrect	DATA DIMENSIONS CONTINUES TO INCORRECTLY REJECT LWP e-BILLS WITH FALSE “Claim Not Found” 277 ACK REJECTIONS.

The DWC offers instructions for how providers and payers must conduct workers’ comp billing and payment: The Medical Billing and Payment Guide and its Electronic Companion Guide. Providers are upholding the “Billing” part of those extensive documents (otherwise, they won’t get paid). It’s time for California to insist that LWP uphold the “Payment” requirements.

daisyBill fights the good fight on behalf of workers’ comp providers. Reach out to see how we can help your practice obtain fast, correct reimbursement for treating injured workers.

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