Electronic Claims Processing - Jopari Solutions, Inc.

Texas -- Ebilling Penalties May Start Jan. 1 in Texas: Top [09/25/07]

Texas insurers and employers say they are still getting the kinks out of the state's new electronic medical billing system, but problems or not, payers that don't meet the Jan. 1 deadline for putting the system in place face administrative penalties of up to $25,000 a day, Division of Workers' Compensation spokesman John Greeley said Monday.

As reported previously by WorkCompCentral, only 274 of 503 carriers had responded to a Sept. 20 deadline to provide the DWC with electronic billing information, including the name, federal employer identification number (FEIN) and telephone number or e-mail address of the payer's e-bill processing agent or agents. Insurers and employers will have to begin accepting electronic bills from health care providers on Jan. 1.

The DWC hasn't gotten out its ticket pad yet, but failure to comply with the ebill reporting requirements next year will be subject to administrative penalties of up to $25,000 per day per occurrence, Greeley said. These penalties could be assessed beginning Jan. 2.

Greeley said the division believes some of the carriers failed to provide information about their electronic medical bill processing agents because they are still "figuring out their relationships" with third party administrators and billing services on how to comply with DWC's requirements."

Joe Woods, vice president and regional manager, Property Casualty Insurers Association of America (PCI), said his impression is that carriers are "trying to figure out what to do and how to do it."

Woods noted that the January deadline for transition to the electronic system is approaching "but I don't think the companies are up to speed on it."

Responses were received from 161 commercial carriers, while 59 others reported to DWC that they were "partially done with getting the information compiled" and should submit it to the division "in a couple of weeks," Greeley said.

The head of the Texas Association of Certified Self-Insurers was out of town and unavailable for comment as to why self-insurers may have missed the deadline.

Only 15 self-insurers reported the required information, while 53 did not.

Responses were received from 98 governmental entities, while 107 failed to respond.

June Kissinger, director of risk management, Texas Association of School Boards Risk Management Fund, which has 335 member school districts, said that the fund expects to be compliant as of Jan. 1.

"There have been some problems...but mainly the same stumbling blocks you have whenever you're transmitting data," Kissinger said.

Selecting a vendor also has been a concern, she acknowledged.

"Because Texas is one of the first states to do this, there are not a lot of vendors out there with experience on this.

"Workers' compensation forms are different from HIPAA (Health Insurance Portability and Accountability Act) forms so you can't just say, 'Oh, yeah. They've been doing this for years,'" Kissinger said.

The division has sent out a reminder notice reminding the non-responders of the requirement to report the information and of resources available to assist them in complying.

DWC also is reviewing the responses which were received to determine if the necessary information has been provided.

The next indication of how well informed carriers are regarding the ebill initiative could come next month. The division is accepting waiver requests from payers up until Oct. 31.

Health care providers are required to begin submitting their bills electronically by Jan. 1, but providers are exempt if they have fewer than 10 employees or if workers' compensation represents less than 10% of their business.

Texas Mutual Insurance Co., the state's largest workers' comp carrier, has already tested its system and will launch its electronic billing system by the Jan. 1 deadline, the carrier said in a press release. Texas Mutual said its system will "comply with workers' compensation electronic billing requirements mandated by the Texas Department of Insurance" and will respond to providers' requests "for a streamlined, paperless billing process."

Texas Mutual has contracted with Jopari Solutions, a California-based supplier of e-billing and payment solutions for the insurance industry, to manage the e-billing system.

Under the agreement, Jopari will serve as a gateway between providers and Texas Mutual for electronic remittance advice and submission of electronic bills and attachments.

Questions on waivers should be directed to Bill Wells at 512-804-5002 or by e-mail to:

bill.wells@tdi.state.tx.us

A list showing the response status and associated information of carriers can be found at:

http://www.tdi.state.tx.us/wc/ebill/index.html

"Health care providers are encouraged to check this Web site frequently for updates," the DWC advised.

--By Bill Kidd, WorkCompCentral Texas Bureau Chief
billkidd@texas.net

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