Providers electronically billing LWP Claims Solutions, be advised that the clearinghouse utilized by this claims administrator is erroneously and systematically rejecting provider e-bills, while also failing to return the required electronic Explanations of Review (EORs) for accepted e-bills.

A clearinghouse is a vendor hired by the claims administrator to accept and respond to providers’ e-bills on the claims administrator’s behalf. Currently, the clearinghouse Data Dimensions (formerly WorkCompEDI) is falsely rejecting e-bills sent by providers for LWP, and failing to return e-EORs for accepted bills processed by LWP.

When the clearinghouse incorrectly rejects a compliant e-bill, the clearinghouse does not forward the e-bill to the claims administrator; therefore, the claims administrator cannot pay the e-bill. For accepted e-bills, e-EORs automatically post payment to the e-bill, close the reimbursement loop, and cut the time and effort necessary to manage practice revenue.

daisyBill has contacted both Data Dimensions and LWP regarding these two outstanding issues. As of 5/19/2022, this e-billing non-compliance remains unresolved.

daisyBill Outreach

daisyBill sent the email message below to LWP, alerting LWP to both outstanding issues and insisting on compliance with California e-billing requirements. Additionally, we reminded LWP that claims administrators are legally responsible for non-compliance by outside vendors such as clearinghouses.

LWP Erroneous e-Bill Rejections

When a clearinghouse falsely rejects an e-bill submitted by one of our clients, daisyBill undertakes the following steps:

1. Designates the e-bill with a DaisyBill Researching status
2. Contacts the claims administrator’s clearinghouse to report the false e-bill rejection
3. Resubmits the rejected e-bill on behalf of our client once the clearinghouse reports fixing the error,
4. Monitors the e-bill until it is ultimately accepted by the clearinghouse and sent to the claims administrator for processing
5. Appends a Non-Compliance Alert to each e-bill history affected by the EDI error

In order for providers to resubmit falsely rejected e-bills for payment, the claims administrator, bill review, and/or clearinghouse entities must repair the underlying technical error causing the improper e-bill rejections.

Ultimately, California law and regulators hold LWP responsible for its e-billing non-compliance, regardless of the failures of any of its vendors. Per the California Division of Workers’ Compensation (DWC) Electronic Medical Billing and Payment Companion Guide:

Billing agents, electronic billing agents, third party administrators, bill review companies, software vendors, data collection agents, and clearinghouses are examples of companies that may have a role in electronic billing. Entities or persons using agents are responsible for the acts or omissions of those agents executed in the performance of services for the entity or person. [emphasis added]

As of this writing, LWP (via Data Dimensions) has erroneously rejected 573 complete, compliant e-bills sent by daisyBill providers.

When a claims administrator fails to adhere to California e-billing requirements, daisyBill notifies our clients by appending a Non-Compliance Alert to the Bill History for each e-bill affected by the EDI error, as shown below.

Below, see the action daisyBill is taking to resolve the EDI Error as noted above.

On 5/18/2022 daisyBill alerted Data Dimensions to the 277 ACK rejection error. For more information, read How to e-Bill: Improperly Rejected e-Bills Explained.

🌼 As of now, daisyBillers do not need to take any action regarding this EDI non-compliance. On your behalf, daisyBill will resubmit all incorrectly rejected bills until the clearinghouse properly responds to these e-bills. Have a Flower Power Day!  

LWP Missing e-EORs

As we explain in this primer on electronic EORs, when providers bill electronically, the claims administrator must return the EOR electronically within 15 working days, in a format known as an X12 835 file.

But in most cases, claims administrators rely on clearinghouses to furnish and return the 835s. However, it remains the claims administrator’s legal responsibility to ensure that e-billing providers receive timely 835s, no matter what other entity the claims administrator employs to facilitate this compliance.

Currently, LWP (via Data Dimensions) has failed to return 835s for 1,854 e-bills sent by daisyBill providers. The Non-Compliance alert appended to daisyBill’s Bill History for each affected e-bill is below.

Below see the action daisyBill is taking to resolve the EDI Error as noted above.

On 5/18/2022 daisyBill alerted Data Dimensions to the X12 835 Missing error. For more information, read How to e-Bill: 835 Electronic EORs.

🌼 As of now, daisyBillers do not need to take any action regarding this EDI non-compliance. Have a Flower Power Day!

daisyBill has the technology and expertise to make workers’ comp work better. Reach out to see how we can help your practice obtain fast, correct reimbursement for treating injured workers.

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