Blog: Daisy News

News, data, & insights about workers' comp billing

header_illustration_blogDaisyBill

The #1 Reason for Audit Complaints

September 30, 2015 by Catherine Montgomery

meta-chart (2).jpeg

In the last 30 days, DaisyBillers submitted over 800 Audit Complaints to California’s Division of Workers’ Compensation. The pie chart above shows that the number one reason providers file Audit Complaints is Processing Overdue, meaning the claims administrator failed to respond to their bill.

For each of these Audit Complaints, a claims administrator ignored the provider’s bill, which tells us that the provider:

  • did not get paid
  • did not receive an Explanation of Review (EOR)
  • had no idea if the bill was incorrect or incomplete
  • did not know how to correct any deficiencies in the bill
  • had no idea if the bill was being processed at all
  • needed to expended more resources to contact the claims administrator

We are certain that the claims administrator received the bill in question. How do we know this? Because DaisyBill’s system guarantees that a provider gets confirmation when a claims administrator receives his or her billa bill simply does not get lost in the mail with DaisyBill.

So there are no valid reasons why the claims administrators did not process and respond to these bills on time.

As a reminder, according to Labor Code 4603.2:

  • For every uncontested bill, the claims administrator must pay in either 45 or 60 calendar days, depending on whether the employer is a government entity.
  • For every contested bill, the claims administrator must send an EOR within 30 calendar days of receipt of the bill or within 15 working days for bills submitted electronically.

It’s unclear why some claims administrators choose to treat Labor Code 4603.2 as though it is optional.

We applaud the providers who take a few moments to file an Audit Complaint when there is no response to their complete and compliant bills. Remember: Audit Complaints provide evidence of improper business practices, bringing noncompliant claims administrators to the DWC’s attention.

Total Audit Complaints by Category

Processing Overdue

431

51%

Denial Incorrect

302

36%

Electronic Billing Noncompliant

50

6%

Penalty & Interest Due

35

4%

EOR Noncompliant

21

3%

Grand Total

839

100%

Go to our Audit Complaint Webinar to learn how to report claims administrators to the DWC. Watch the webinar video or download the slides--both are free!

WATCH + VIEW

Search results for:

intercom_chat_bubble_icon