daisyBill is aware of confusion regarding the correct Payer ID providers should use when submitting e-bills to Sedgwick, a third-party administrator (TPA).

The correct, current Sedgwick Payer ID number is WX867, as assigned by Sedgwick’s current e-billing clearinghouse vendor, Data Dimensions (formerly WorkComp EDI).

The reason for this EDI alert is that Sedgwick representatives are incorrectly instructing providers to use an outdated Payer ID number (TP097). This incorrect Payer ID belongs to Sedgwick’s previous clearinghouse, Availity.

To add a dose of duplicity, Sedgwick representatives are falsely asserting that e-bills sent using the correct Payer ID WX867 are not on file because WX867 is an incorrect Payer ID for Sedgwick (to repeat, WX867 is the correct Sedgwick Payer ID).

Moreover, regardless of whether providers (correctly) use WX867, or (incorrectly) use TP097, Sedgwick cannot truthfully claim that these e-bills are not on file. Data Dimensions has reported to daisyBill that even if providers use the incorrect, outdated Payer ID number TP097 (which we do not recommend), Data Dimensions will correctly route the e-bill to Sedgwick, regardless.

Despite Data Dimension’s assurances, the best way to ensure reimbursement is to use the correct Data Dimensions Sedgwick Payer ID WX867.

How to Send e-Bills to Sedgwick

As we outline here, when a claims administrator lacks the technology to process e-bills, the claims administrator (including Sedgwick) hires a clearinghouse vendor to accept e-bills from providers.

Data Dimensions is the clearinghouse Sedgwick chose to accept providers’ e-bill submissions on Sedgwick’s behalf. In 2021, daisyBill successfully sent Sedgwick 264,420 e-bills; the correct e-billing protocol for Sedgwick is as follows:

1. The provider sends the e-bill to Sedgwick’s clearinghouse, Data Dimensions, using the Payer ID number that Data Dimensions assigned to Sedgwick: WX867.
2. Data Dimensions accepts the e-bill on Sedgwick’s behalf.
3. Data Dimensions sends the provider a timely 277 acknowledgment verifying that Sedgwick received the e-bill for processing.
4. Within 15 calendar days, California law mandates Sedgwick must both pay the provider and return EOR data to Data Dimensions.
5. Data Dimensions electronically sends the provider the Sedgwick EOR data.

Sedgwick e-Billing Misinformation

After the 15-day deadline for Sedgwick to electronically return the EOR for a provider’s e-bill elapsed, a daisyCollect agent reached out to Sedgwick to determine the reason that Sedgwick failed to timely pay the daisyCollect client. After an hour-plus wait on hold, our agent spoke to a Sedgwick representative, and the treachery commenced.

First, the Sedgwick representative claimed that Sedgwick did not receive the e-bill. Sedgwick claimed to have no bills for the date of service in question. This assertion is patently false — Data Dimensions sent the provider the mandated 277 acknowledgment verifying Sedgwick received the bill, as displayed below.

When daisyCollect confirmed that daisyBill sent the bill using Data Dimensions Payer ID number WX867, the Sedgwick representative asserted the Payer ID number for Sedgwick bills is TP097 — an outdated Availity-assigned number.

Yet when our agent repeatedly asked if the Sedgwick representative was sure about the incorrect correct Payer ID, the Sedgwick representative was as doubtless as they were wrong, claiming “...it's always been that TP097.”

We reported on Sedgwick’s split with Availity last summer. The Data Dimensions website currently lists Sedgwick as one of its payer clients.

Our agent followed up with Data Dimensions, asking the clearinghouse to confirm the correct Payer ID number. Data Dimensions confirmed that TP097 is incorrect, and WX867 is the correct Payer ID. AND, Data Dimensions also claimed that their system reroutes bills submitted using the incorrect TP097 to the correct destination — a claim that, again, we cannot recommend providers take on faith.

Submit your e-bills to Sedgwick using Data Dimensions Payer ID number WX867, and take appropriate action if Sedgwick fails to respond timely and compliantly. Watch this space for how daisyBill is automating the submission of Audit Complaints to the DWC when claims administrators inflict this type of treachery on the providers who treat California’s injured workers. 

daisyBill fights for the providers who treat injured workers. Learn how we can make authorization, billing, and appeals easier, faster, better for your practice.

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