Self-insured employer Marriott denied payment for two electronic bills (e-bills) on a New York injured worker's claim, but left the provider (plus its bill review and clearinghouse vendors) completely in the dark about its refusal to pay.

Marriott's failures of communication broke New York's mandatory e-billing "loop," which requires:

• Providers to submit e-bills through their e-billing submission partners, and
• Payers to respond with the required electronic Explanations of Benefits (e-EOBs), which automatically post payment details to the providers' e-billing system, through their clearinghouses.

When the provider received no response to its e-bills, daisyBill's Compliance Team contacted Marriott’s bill review vendor, Genex, to investigate. But rather than investigating the actual reasons for the non-payments, Genex compounded the problem by:

1. Misidentifying the root problem, claiming that the provider had used an incorrect Payer ID number to submit the e-bills
2. Furnishing a new, totally incorrect Payer ID number for Marriott
3. Directing the provider to resubmit the e-bills using that incorrect Payer ID number

Had the provider followed Genex's instructions, it would have wasted time and resources chasing a dead end of Genex's making. As a bill review vendor, it’s part of Genex’s job to provide accurate information; for it to offer wildly inaccurate misinformation instead is a disservice to both the provider and its client, Marriott.

Fortunately, Marriott’s clearinghouse vendor, Data Dimensions, stepped up where Genex failed, correctly identifying the root of the problem: Marriott’s failure to abide by New York’s e-billing requirements.

Genex Shares Misinformation

Initially, Genex told the provider that the e-bills in question were not on file, prompting daisyBill’s Compliance Team to investigate.

In most cases, to successfully submit an e-bill, a provider or their e-billing agent needs two key pieces of information: the clearinghouse through which the payer accepts e-bills, and the specific Payer ID number that clearinghouse assigns to the payer. Genex told daisyBill that the Payer ID number the provider had used, WZ787, was not the Payer ID assigned by Data Dimensions to Marriott. The Genex agent claimed that the correct Marriott Payer ID is WZ2787, and suggested resubmitting the e-bills.

Genex was incorrect.

daisyBill maintains an up-to-date list of correct Payer IDs that we use to route e-bills through our proprietary network of direct e-billing connections to each clearinghouse. Had this provider followed Genex’s instructions, it would have led precisely nowhere.

Marriott Ghosts Clearinghouse and Ignores NY Payment Rules

When daisyBill reported Genex's misinformation to Data Dimensions, the clearinghouse confirmed that the Payer ID Genex provided (WZ2787) was invalid.

Ultimately, Data Dimensions reached out to Marriott and discovered that a Marriott adjuster had denied payment and filed the required denial form, the C-8.1B, to the WCB. However, Marriott had failed to inform its clearinghouse, breaking the e-billing loop (and leaving the provider out of the “loop” altogether).

While submitting the C-8.1B to the WCB is a requirement for payers denying reimbursement, it’s not the only requirement. A copy of the C-8.1B must go to the provider and injured worker as well. More importantly, New York has required all payers to respond to e-bills with e-EOBs since October 2021. The WCB has affirmed this requirement multiple times in various announcements and on its FAQ page.

When payers fail to send e-EOBs, providers must expend their time and resources to manually post payment information to each bill. Moreover, the WCB never receives the data it needs to monitor for compliance and otherwise study and improve the system.  

Generally, clearinghouses like Data Dimensions issue e-EOBs on behalf of their payer clients. However, the clearinghouse cannot issue an e-EOB if the payer fails to provide any payment or denial information.

Once again, Marriott has demonstrated its inability to handle workers' comp claims properly. We've seen multiple failures and violations of California workers' comp requirements by Marriott (and misinformation from Genex on behalf of Marriott) over the years.

Now, apparently, Marriott's failure to navigate New York's system is creating similar havoc on the opposite coast.

Don’t settle for a clearinghouse. daisyBill is a WCB-approved e-billing partner for NY providers. Click below to see more:

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