Blog: Daisy News

Broadspire, a global third-party claims administrator (TPA), incorrectly denied several bills for the treatment of an injured worker. While incorrect denials are nothing new in California workers’ comp, one thing makes this situation even more egregious: by Broadspire’s own admission, the denied bills were still in process.

What’s more, the usual billing and payment process is further complicated by the provider’s inclusion in a network. As this situation demonstrates, the benefits of participating in some networks are dubious at best — especially considering the payment hassle networks can create.

Effective May 1 of this year, insurers Allianz and Fireman’s Fund Insurance Company (FFIC) merged their payment systems for California workers’ comp to reflect Allianz’s 2015 acquisition of FFIC. As part of this transition, Allianz established two new electronic billing payor IDs for all claims, including those claims formerly administered by FFIC.

For electronic billing, Allianz and FFIC previously used two separate payor IDs. Effective May 1, 2018 Allianz continues to use two payor IDs; the correct choice of payor ID is dependent on the Date of Injury (DOI) for the claim in question.

Most claims administrators lack the technology to process electronic bills from providers. Instead, these claims administrators rely on clearinghouses. Since DaisyBill has direct access to all 5 California clearinghouses, we’re uniquely qualified to evaluate and compare the performances of each. With this series, we take a look at the value each clearinghouse adds to (or subtracts from) workers’ comp.

To kick this clearinghouse series off, we’ll start with the most efficient kind of clearinghouse: no clearinghouse at all.

Corvel Corporation is not a clearinghouse, per se. But CorVel is something even more important: a claims administrator that essentially functions as its own clearinghouse, directly accepting and processing providers’ electronic bills. This vastly reduces complications and potential friction for providers and employers, both of whom benefit from CorVel’s integrated approach.

We applaud any time a claims administrator’s practices make things simpler for all concerned. By taking on the duties of a clearinghouse, CorVel sets a new standard of efficiency.

It happens far too often: providers treat an injured worker for a California employer, send the bill to the claims administrator, and then...nothing.

Workers’ comp is frustrating enough, but few things are more irritating than hearing crickets in response to a compliant original bill. Fortunately, California law offers remedies. Here’s how to obtain reimbursement (and address blatant non-compliance) when the claims administrator fails to respond to your bill.

If your office looked to the Lockard Industrial Insurance Companies’ List to find contact information for workers’ comp payors, you’ll need to look elsewhere.

The green spiral-bound book containing addresses, phone and fax numbers, and email addresses for almost every insurance and third party administrator in California is no more. Previously released annually with new information, the directory’s last edition was published in 2016. Like vinyl records and VHS, Lockard’s List was much loved, but ultimately outpaced by the Digital Age.

All information previously available in Lockard (and more) is available through DaisyBill’s Work Comp Wizard.

DaisyBill providers stood firm in demanding timely, correct payments in 2017 by using our Audit Complaints Tool to report payor noncompliance.

We always advocate for compliance on both sides of the workers’ comp transaction. That said, the consequences for provider violations are immediate and automatic, while the payors (insurers, self-insured employers, and their claims administrators) are subject to repercussions only when the Division of Workers’ Comp (DWC) takes action. This year, our providers submitted almost 3,000 Audit Complaints, alerting the DWC when claims administrators failed to follow regulations

The data on this year’s violations help paint a picture of which infractions create the most friction for providers.

When it comes to medical-legal billing, the workers’ comp field is missing something.

For medical-legal bills, no rules govern the billing form used or the method used to submit these bills. Technically, sending a medical-legal bill on a napkin via carrier pigeon is as compliant as sending the same bill on a CMS 1500 through the mail. This regulatory blind spot leads to unnecessary confusion and billing disputes, increasing friction and wasting the time of providers and payors alike.

California does not make it easy for work comp providers to get paid. The time and effort necessary to obtain proper reimbursement is an unfortunate reality of a system weighed against providers’ interests. But all is not hopeless. Work comp providers can ensure correct, timely payment for the treatment of injured workers.

They just need to know how.