Several providers recently received incorrect denials of bills from California’s State Compensation Insurance Fund (SCIF), the state’s largest provider of work comp insurance. These original bills were denied for untimely submission, despite having been submitted within the required timeline. Senate Bill 1175 mandates a 12-month deadline for original bill submission.

A SCIF representative acknowledged the error, as the insurer moved quickly to resolve it.

SCIF’s in-house bill review identified an unspecified system glitch as the source of the incorrect denials. According to their representative, SCIF fixed the glitch and intends to reprocess all incorrectly denied bills. We recommend that any providers who received incorrect denials for untimely submission submit requests for second review to ensure their bills are reprocessed.

Despite the error, SCIF has a laudable history of quick payment times and above-average responsiveness, even voluntarily paying self-executing penalties and interest for (admirably rare) late payments. We expect providers will have little trouble obtaining proper reimbursements for the mistakenly denied bills.

SB 1175’s 12-month deadline took effect January 1, 2017. Applicable to both medical and medical-legal services, timely filing deadlines apply to all providers of services provided pursuant to Section 4600 of the Labor Code, including, but not limited to physicians, hospitals, pharmacies, interpreters, copy services, transportation services, and home health care services.

While SCIF denied these bills in error, the incident serves as an important reminder that timely filing is now a legal requirement. Providers, be sure to submit bills within 12 months of the date of service. If a bill is not submitted in time, the insurer or employer’s claims administrator is under no legal obligation to pay!

The 12-month deadline continues to apply for 2018 dates of service, with the exception of services “automatically” authorized under the new fast-track utilization review process — for which bills must be submitted much more quickly, within 30 days of service.

We’ll keep readers posted of any further developments. Meanwhile, we urge providers to adhere to the mandated timeframes, and demand proper reimbursement for compliantly submitted bills.

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