Third-Party Administrator (TPA) LWP Claims Solutions is in violation of California workers’ comp e-billing law. LWP’s persistent failure to honor state requirements places an undue burden on medical practices, and defeats the purpose of e-billing, which was designed to make workers’ comp more efficient and facilitate the treatment of injured workers.

Below, see the details of the latest batch of formal Audit Complaints daisyBill submitted to the Division of Workers’ Compensation, on behalf of our clients and all California providers who choose to treat injured workers.

LWP: Ignoring CA Law

To: XXXXXXXX@dir.ca.gov

Subject: #2 LWP Invalid 277 ACKs: Untimely Reject After Prior Accept - 2,075 Audit Complaints

For California workers’ compensation EDI transactions the Division of Workers’ Compensation (DWC) issued a comprehensive Electronic Medical Billing and Payment Companion Guide that lists EDI requirements that providers and payers must follow.

LWP fails to adhere to 277 Acknowledgment (ACK) requirements mandated by the DWC.

EDI Noncompliance #1: For 1,618 e-bills, Data Dimensions (the clearinghouse vendor that represents LWP) sent a timely 277 ACK accepting the e-bill and subsequently an untimely 277 ACKs rejecting the same e-bill.

EDI Noncompliance #2: For 457 e-bills, Data Dimensions (the clearinghouse vendor representing LWP) failed to send providers a timely 277 ACKs.

Since Data Dimensions does not forward the rejected e-bills to LWP, this EDI noncompliance results in a significant administrative cost for providers as follows:

• In addition to the cost incurred to submit the e-bill that Data Dimensions rejected, providers incur an additional cost to resend a duplicate paper bill to LWP.

Below we offer extensive evidence documenting how LWP and its clearinghouse act in tandem to ignore California EDI 277 Acknowledgement requirements.

277 ACK: Reject/Prior 277 Accept Explained

Per Chapter 9 Companion Guide Acknowledgments, when a provider transmits an e-bill to a payer (or the payer’s clearinghouse), within two working days of receipt of an e-bill, the payer must send the provider an ASC X12N/005010X214 Health Claim Acknowledgment (277) advising either the e-bill was accepted or rejected for payment adjudication.

• This e-bill processing step, prior to adjudication, is to verify that the bill concerns an actual employment-related condition that has been reported to the employer and subsequently reported to the claims administrator. 

For the period 1/1/2022 through 7/31/2022, for 1,618 e-bills submitted to LWP, the clearinghouse Data Dimensions

1. Sent the provider a timely 277 Acknowledgment accepting the e-bill for processing with a Claim Status Category Code and Claim Status Code as follows:

• A1 - The bill has been received.
• 20 - Accepted for processing.

2. Sent the provider an untimely 277 Acknowledgment rejecting the bill for processing with a Claim Status Category Code and Claim Status Code as follows:

• A6 - The bill has been rejected for Missing Information.
• 629 - Property Casualty Claim Number
• Note - CLAIM NOT FOUND

CSV #1: 277 ACKs Untimely - Reject After Prior Accept - Attached is a CSV listing 1,618 e-bills daisyBill providers submitted to LWP where LWP failed to accept the e-bill sent in the X12 837 format. The table below indicates the relevant CSV columns demonstrating the following:

1. Column O: 277 ACK Receipt Due Date - Two working days after Data Dimensions received the e-bill,
2. Columns P & Q: Receipt Date of the initial 277 ACK accepting the e-bill,
3. Columns S & T: Receipt Date of the subsequent untimely 277 ACK rejecting the same e-bill,
4. Column U: STC Category-Code sent rejecting e-bill, and
5. Column AW: STC Reject Description

277 ACK - Untimely Explained

Per Chapter 9 Companion Guide Acknowledgments, when a provider transmits an e-bill to a payer (or the payer’s clearinghouse), within two working days of receipt of an e-bill, the payer must send the provider an ASC X12N/005010X214 Health Claim Acknowledgment (277) advising either the e-bill was accepted or rejected for payment adjudication.

CSV #2: 277 ACKs Untimely - This CSV lists 457 e-bills daisyBill providers submitted to LWP where LWP failed to timely send the provider a 277 ACK.

Audit Complaint Details

This Audit Complaint Data submitted to the DWC represents a credible complaint and credible information of claims handling violations for 2,075 e-bills submitted to LWP by providers that treat injured workers.

Effective October 2012, DWC Rule 7.1 requires the claims administrator to accept workers’ comp e-bills from providers in the X12 837 format.

Noncompliance: Per Chapter 9 Companion Guide Acknowledgments, when a provider transmits an e-bill to a payer (or the payer’s clearinghouse), within two working days of receipt of an e-bill, the payer must send the provider an ASC X12N/005010X214 Health Claim Acknowledgment (277) to advising either the e-bill was accepted or rejected for payment adjudication.

CCR §10106.1(c)(3) instructs that the Audit Unit “shall review and compile complaints” that indicate a claims administrator is “failing to meet their obligations under Divisions 1 or 4 of the Labor Code or regulations of the Administrative Director.”

Pursuant to LAB §129, CCR §10106.1(c)(3) provides the DWC Audit Unit may target audit subjects based on: “...credible complaints and/or information received by the Division of Workers' Compensation that indicate possible claims handling violations, except that the Audit Unit will not target audit subjects based only on anonymous complaints unless the complaint(s) is supported by credible documentation.

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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