Alert: CA State Fund e-Bills Erroneously Rejected

Alert: CA State Fund e-Bills Erroneously Rejected

Jopari, the clearinghouse utilized by California’s State Compensation Insurance Fund (SCIF), erroneously rejected providers’ electronic bills as “duplicates” beginning January 23, 2024.

On January 23rd, daisyBill’s automated system for detecting e-billing errors alerted our team to a problem with SCIF e-bills. Immediately, a daisyBill representative contacted Jopari with details of the erroneously rejected e-bills.

A Jopari representative responded, “I have escalated this inquiry internally for research and will update you once I have more information.” However, Jopari failed to provide daisyBill with “more information.”

Consequently on February 8th, daisyBill contacted SCIF leadership. In less than two days, SCIF quickly identified the source of the error and implemented a solution. Most importantly, SCIF leadership kept daisyBill informed throughout their investigation.

daisyBill resubmitted all affected e-bills to SCIF on behalf of our clients. However, providers who do not use daisyBill should double-check the payment status of any bills submitted to SCIF in January.

Further details are below.

Jopari Erroneous e-Bill Rejections

Clearinghouses accept e-bills on behalf of claims administrators, which lack the technology to accept e-bills directly from providers. daisyBill software monitors and tracks the status of all e-bill submissions by our clients; if a clearinghouse erroneously rejects an e-bill, daisyBill takes the following steps:

  1. Assigns the e-bill a daisyBill Researching status
  2. Contacts the claims administrator’s clearinghouse to report the improper 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 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 error

Commencing January 23rd, daisyBill began receiving error alerts for SCIF e-bills. Over the following several days, Jopari erroneously rejected over 1,000 SCIF e-bills.

Below is an example. On January 12th, Jopari initially responded to an e-bill with the required electronic “receipt” known as a “277 Acknowledgement (277 ACK)”, indicating that Jopari accepted the e-bill.

But oddly, instead of forwarding the e-bill to SCIF for payment, Jopari subsequently sent two additional 277 ACKs indicating that the (already accepted) e-bill was accepted. On January 23rd, Jopari sent a 277 ACK indicating that the (now thrice-accepted) e-bill was rejected.

Over 1,000 SCIF e-bills were similarly affected by Jopari’s apparent glitch. On January 24th, daisyBill alerted Jopari to the erroneous rejections.

Jopari Fumbles, SCIF Recovers

As of February 8th, Jopari representatives had yet to provide updates on these erroneously rejected e-bills. daisyBill, therefore, contacted SCIF with the details of the issue.

SCIF leadership responded immediately, quickly investigating the problem and identifying the underlying cause, which SCIF reported as a Jopari error. Further, SCIF reported that it had begun implementing the solution to process the e-bills impacted by the rejection error.

Technical issues will occur in e-billing; how claims administrators respond matters. SCIF has set an admirable example. Once again, we commend SCIF for taking responsibility for compliance and rapidly taking steps to reimburse California providers that treated SCIF injured workers.

daisyBill makes workers’ comp billing easier, faster, and less costly. Request a free demonstration below.


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