Provider FYI: If you’re paying an electronic billing vendor, but still using a fax machine (or even worse, a mailbox) to send supporting medical documents, you’re not getting what you paid for.

Many (non-client) providers complain of denied e-bills due to “missing documentation.” That’s because rather than electronically submitting PDFs of supporting documents with each e-bill, these providers fax the documents separately.

When medical documents are sent electronically as PDFs with e-bills, the documents do not get “lost” or go “missing.”

Read on to see how workers’ comp e-billing software should handle supporting medical documents — and why any software product that doesn’t include electronic document submission doesn’t qualify as workers’ comp e-billing technology.

Medical Documents: Required for Workers’ Comp e-Billing

Most states require providers to send workers’ comp e-bills with PDFs of the medical documents substantiating the treatments. Sending this documentation should be as simple as uploading the PDFs to the e-billing software.

Once the provider uploads the PDFs:

1. The e-billing software packages the medical documents into a ‘275’ file.
2. The e-billing software sends the 275 file with the e-bill to the clearinghouse vendor used by the claims administrator.
3. The clearinghouse forwards the medical document PDFs to the claims administrator.

No faxing is required, ever.

More importantly, submitting PDFs with the e-bill eliminates the possibility of “missing” medical documents, because the provider can prove that 1) the documents were sent and 2) the clearinghouse received the documents.

In the event a claims administrator reports to a daisyBill provider that medical documents are missing, our agents contact the clearinghouse to determine why:

• The clearinghouse failed to transmit the documents correctly, or
• The claims administrator failed to receive the documents.

Tracking down supposedly “missing” documents is never a daisyBill provider’s responsibility. Never.

Workers’ comp providers who do not use daisyBill often report payment denials resulting from supporting documents getting lost in the mail, or PDFs lost due to the inability of standard group health e-billing software to attach and transmit these documents correctly.

This missing documents problem is extremely common, and one of the top reasons workers’ comp providers abandon e-billing and revert to slow, expensive paper billing. But it’s not a problem for daisyBillers.

Secure Document Transmission Explained (With Video)

When a practice staff member imports or enters billing data into daisyBill, our software automatically prompts the provider to upload PDFs of the required supporting documents. daisyBill packages the PDFs into a 275 file, accepted by most clearinghouses (and by payers that do not use a clearinghouse).

Important note: daisyBill also transmits the e-bill and documents to the specific clearinghouse hired by the payer where applicable, avoiding the sloppy rerouting of files caused by software that sends all bills and documents to a single clearinghouse.

Both the bill file (in ‘837’ file format) and the document file (in 275 format) are assigned the same unique “attachment control number.” This allows the clearinghouse to match the bill file (837)  with its corresponding document file (275). The attachment control number ensures that the bill arrives with its documents.

With the correct submission of supporting documents, the promises of workers’ comp e-billing comes to fruition. The provider gets paid faster, treating injured workers becomes more manageable, and workers’ comp becomes a better financial proposition.

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

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