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Coventry Incorrectly Processing Bills December 2015
Review all EORs processed by Coventry
Los Angeles County 3000 Claims to Tristar
Direct Los Angeles County 3000 claims to Tristar
Intercare: Sussex / Companion Insurance
Sussex Insurance, formerly known as Companion Property and Casualty Insurance (hereafter referred to as Sussex / Companion) uses Intercare Holdings Insurance Services, Inc. at Glendale as its third-party administrator. For bill review services, Sussex/Companion now uses Paladin Managed Care Services; it no longer uses InterMed for bill review.
BHHC / Guard
Even though Guard Insurance is a member of the Berkshire Hathaway Homestate Companies (BHHC), Guard claims numbers are distinctly different from BHHC claim numbers. Additionally, for electronic billing Guard and BHHC maintain separate electronic connections. It can be difficult to figure out which connection to use - unless you’re a DaisyBill user!
Some Chubb Bills Moved to Gallagher Bassett
During October 2014, it came to DaisyBill’s attention that Gallagher Bassett would administer some workers’ comp claims formerly administered by Chubb. Needless to say, this has caused some confusion about where to send Chubb bills, which claims are affected, and whether new claim numbers are required for submission.
ACCA aquired by Berkshire Hathaway Homestate Companies
In 2006, a Berkshire Hathaway subsidiary acquired American Commercial Claim Administrators (ACCA).
Everest National Insurance
DaisyBill lists Everest National Insurance (Everest) as an Invalid claims administrator because Everest does not directly accept bills for California Workers’ Compensation Claims.
Speciality Risk Services acquired by Sedgwick
According to multiple news sources, in 2011 Sedgwick CMS acquired Speciality Risk Services (SRS) from The Hartford Financial Services Group.
Travelers Insurance Rejected Bill Status
Travelers Insurance rejects bill submissions if the Patient or Injury information does not exactly match the information on file with Travelers. Edit and correct the necessary information prior to re-submitting the bill.
Sentry Insurance Rejected Bill Status
Sentry Insurance rejects bill submissions if the Patient or Injury information does not exactly match the information on file with Sentry. Edit and correct the necessary information prior to re-submitting the bill.
Employers Insurance Rejected Bill Status
Employers Insurance rejects bill submissions if the Patient or Injury information does not exactly match the information on file with Employers. Prior to resubmitting a rejected bill, edit and correct the necessary information.
Springfield Is Now AmTrust
In 2015 AmTrust Financial Services, Inc. acquired Springfield Insurance Company, a Unified Grocers Company. According to representatives from both AmTrust and Springfield, providers must submit all former Springfield bills directly to AmTrust North America.
SCIF: Incorrect 'Not Authorized by UR' Denials
In mid-February 2016, a DaisyBiller reported that State Comp Insurance Fund (SCIF) was incorrectly denying bills for authorized treatment as “not authorized by UR.” DaisyBill contacted SCIF, and a representative confirmed that SCIF may be erroneously denying authorized treatment as not authorized.
EOR Noncompliant: EOR remitted by claims administrator lacks required information
For bills submitted electronically, Zurich no longer issues paper Explanations of Review (EORs). While we commend Zurich for embracing e-billing, many Zurich electronic EORs lack critical and required bill adjudication information.