When non-client providers contact us about workers’ comp e-billing, they inevitably share frustrations based on certain myths. In this series, we address the most common e-billing misconceptions.

Myth: An e-bill can be sent using any clearinghouse that delivers e-bills.

Providers often report calling a claims administrator to ask about a missing payment, only to hear that the e-bill is “not on file.” Or that the e-bill was printed and faxed or mailed instead of being delivered electronically, delaying payment by weeks or more.

Some providers believe lost e-bills occur because e-billing is prone to failure; this belief is patently false. Often, the problem arises because the provider submits all their e-bills to a single clearinghouse that has no direct connection with the claims administrator (aka the carrier or payer).

In the brief video below, we explain how daisyBill submits over 92% of its millions of workers’ comp bills electronically, by using the specific clearinghouse directly connected to each claims administrator.

e-Bill Delivery: A Complex (But Manageable) Challenge

Every claims administrator (except two) hires one of four clearinghouses (Jopari, Data Dimensions, Carisk, or P2P) to accept e-bills from providers. The two exceptions are Third-Party Administrator (TPA) CorVel and the federal US Department of Labor (DOL), which have the technology to accept e-bills directly from providers.

In 2023, daisyBill sent 2,401,504 bills in total.

Of those bills, daisyBill delivered 92.5%, or 2,222,000 bills, electronically as e-bills to the four clearinghouses, CorVel, and the DOL as follows:

• 46% were sent Data Dimensions, a clearinghouse
• 39% were sent to Jopari, a clearinghouse
• 8% went directly to CorVel, a Third-Party Administrator (TPA)
• 6% were sent to Carisk, a clearinghouse 
• 1% were sent directly to the Department of Labor (DOL)
• Less than 1% went P2P, a clearinghouse 

The table below lists the “Top 3” claims administrator clients for each clearinghouse (as measured by the volume of e-bills daisyBill sent to the clearinghouse on behalf of claims administrators).

As discussed in our last debunking, it is often challenging for clearinghouses to deliver bills through another clearinghouse, or to CorVel or the Department of Labor. For example, Data Dimensions may struggle to send e-bills to CorVel, since CorVel uses a unique Payer ID system to identify CorVel’s clients.

Establishing a network of workers’ comp e-billing routes has been daisyBill’s primary work for the last 12 years. This focus on properly delivering e-bills allows daisyBill to send 92% of workers’ comp bills electronically.

Can Any Clearinghouse Deliver All Your e-Bills?

Before you consider e-billing with any software vendor or clearinghouse, be sure to ask the following questions:

1. What percentage of clients’ total e-bills are sent to each clearinghouse? If their numbers differ significantly from our numbers above (or reflect the use of only a single clearinghouse), ask why.

2. Does your software allow the provider to see exactly how each e-bill is delivered (e.g. as an e-bill, or via fax or email)? daisyBill shows how each and every bill was sent.

3. How does the company manage the thousands of unique Payer ID numbers assigned by clearinghouses to claims administrators? For example, Sedgwick has around a dozen Payer IDs, depending on the employer, while CorVel has hundreds.

If the clearinghouse or other vendor can’t answer these questions to your satisfaction, be aware of the risks. Insist on finding out whether they have direct e-billing routes to ensure high rates of successful e-bill delivery.

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