Blog: Daisy News

On Tuesday, October 9, Optum Property and Casualty Clearinghouse suffered a major systems issue, preventing Optum from receiving, processing, or responding to electronic bills from providers. The shutdown persisted for a week, until Optum was able to restore systems on Tuesday, October 16.

After resolving the glitch, Optum pledged to contact all clients and partners individually to ensure that all data is accounted for, and ultimately processed. DaisyBill clients can rest easy, as our automated systems keep track of all data, response times, and tasks required to complete the billing and payment process.

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.

Mistakes happen.

When a provider accidentally submits an original bill that contains an error, taking the appropriate action is key to avoiding further delay in reimbursement. Often, providers attempt to submit revised or corrected bills, rather than waiting to submit a second review appeal.

Theoretically, submitting a corrected bill can seem like the appropriate option in some situations. In reality, the process of resubmitting a corrected bill is undermined by poorly constructed regulations, and is completely unreliable — even pointless.

Multiple providers allege that a major clearinghouse fed them inaccurate information about electronic billing in California. According to these providers, the clearinghouse in question insists that many claims administrators do not accept electronic billing for worker’s comp, necessitating paper bills. In truth, every major claims administrator in California does, in fact, accept electronic bills.

This casts serious suspicion on the clearinghouse’s motives.

Today, we continue our multi-part examination of compliant electronic billing for California workers’ comp bills. We kicked off the series with a primer, before diving into electronic EORs and EDI agent responsibilities. Now we turn to another issue that plagues providers across the state. When we speak to providers about the complexity of the workers’ comp electronic billing system, a common error stands out: indirect routing of electronic bills.

Over the past several weeks, we’ve taken a close look at various aspects of compliant e-billing for California workers’ compensation bills. Today, we turn our focus to the role of EDI agents such as DaisyBill. EDI agents are a crucial cog in workers’ comp billing – providers and claims administrators are not equipped to generate and receive the various electronic files that underpin the e-billing system. Choosing a good EDI agent – and knowing their responsibilities – is crucial to billing success.

This month, we’ve placed an emphasis on analyzing and explaining the vagaries of electronic billing for California workers’ compensation medical bills. The state’s Division of Workers’ Compensation (DWC) requires that providers who choose to submit electronic bills and all claims administrators follow the electronic billing rules set out in its 65-page Electronic Billing and Payment Companion Guide. To be clear, these rules are not optional. Yet some claims administrators demonstrate habitual non-compliance. Today, we zero in on the failure to return an electronic Explanation of Review (EOR).

Last week in this space, we published an introductory primer on compliant workers’ compensation electronic billing. Since its introduction in 2012, electronic billing has consistently offered providers a fast, efficient, and reliable avenue for processing their workers’ comp bills. This week, we examine rejected electronic bills – why this happens, what it means, and how rejections actually benefit the workers’ comp system.