Why Your e-Bill Didn't Make It to the Claims Admin

Why Your e-Bill Didn't Make It to the Claims Admin

If you’ve tried e-billing for workers’ comp patients — and it didn’t go well — you probably noticed many e-bills getting lost, dropped to paper and mailed, or reported “not on file” by the claims administrator.

The reason is simple: your e-billing software vendor sent the e-bill to the wrong clearinghouse.

Why does this happen? Because most e-billing software cannot deliver workers’ compensation e-bills to the clearinghouse hired by the claims administrator. Instead, the software sends all workers’ comp bills to a single clearinghouse, expecting that clearinghouse to forward your e-bill if necessary.

Once your e-bill is initially sent to the wrong clearinghouse, it is often a roll of the dice whether your e-bill makes it to the correct one.

Below, see a brief explanation of this issue.

Learn how e-bill delivery works at our free 15-minute “Webinette” + Q&A, available to watch here.

How e-Bills *Should* Be Delivered

Most claims administrators can’t accept and process e-bills. Whether the claims administrator is an insurer, employer, or Third-Party Administrator (TPA), these entities don’t maintain the necessary technology to accept e-bills from the thousands of workers’ compensation providers.

So, claims administrators hire clearinghouses to accept providers’ e-bills.

The clearinghouse receives e-bills from providers and then forwards the bill data to their claims administrator client. The correct route for a workers’ comp e-bill looks like the following.

Step 1: Provider enters billing information into e-billing software

Step 2: e-Billing software converts bill data into an e-bill (X12 837 file) and delivers the e-bill and supporting documents to the clearinghouse hired by the claims administrator

Step 3: Clearinghouse forwards e-bill to claims administrator

In a perfect world, the e-billing software knows the correct clearinghouse for the claims administrator being billed. It delivers the e-bill to that clearinghouse, and that clearinghouse forwards the e-bill to the claims administrator for payment.

In the real world, the e-billing software often does not know the correct clearinghouse for the claims administrator. It therefore delivers the e-bill to the software vendor’s preferred clearinghouse. The e-bill (and/or the supporting documents sent with the e-bill) ends up “not on file” (read: lost in the ether).

Sending an e-bill to the correct clearinghouse is the best (and only) way to guarantee e-bill delivery and lightning-fast payment. That was the whole intention of e-billing: to make the administrative side of workers’ comp faster, easier, and more efficient.

Learn more essential e-billing details with our webinar and Q&A!

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


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