The Division is holding stakeholder groups and informational meetings regarding the eBill system that went into effect January 1, 2008. The Texas legislature requires medical providers to submit their bills electronically to carriers. Each carrier must have taken the appropriate steps to accept eBills from medical providers. Some carriers and medical providers were temporarily granted a waiver. In the future, such waivers will not be approved.
The two primary issues concerning eBill are (1) connectivity and (2) documentation. Connectivity is a process where a medical provider can submit bills to every carrier and every carrier can receive medical bills from every provider. Unfortunately, not all vendors have connectivity with all parties. (Carriers are strongly urged to investigate connectivity limitations of their vendor and take necessary action. Carriers will be subject to administrative violations if this issue is not addressed internally.)
The second issue is documentation. The DWC believes there are two kinds of documentation: 1) medical records for case management purposes which can be rather large; and 2) documentation that supports the medical bill. The Division has issued a memo inviting medical providers to refer insurance carriers for administrative violations if carriers require more than necessary to document a medical bill. Recent communication with some Division employees indicate a clear hostility toward carriers. In fact, the Division believes carriers need simply hire a good eBill agent and problems will disappear. Some carriers point out the Division does not have any real world experience with these issues. Texas, California, and
Minnesota are the first states requiring eBilling. Other states are expected to follow. Therefore,
Texas is creating the model for other states’ eBill initiation for workers compensation bills.
Currently, healthcare providers can submit documentation that supports the medical bill electronically utilizing the 275 format. Unfortunately, many of the vendors and clearinghouses do not support (or do not wish to support) the 275 format.
California is apparently requiring providers to submit their documentation electronically.
California’s system matches the eBill with the documentation. In
Texas, healthcare providers are allowed to submit documentation by fax or email. The Division believes it is the carriers’ responsibility to attach the medical bill with the documentation. An underwriting carrier may have several different lines of business in
Texas. The carrier may hire multiple third party administrators (TPA) and multiple eBill agents. Healthcare providers could send the medical documentation by fax to the home office, a different office than the one administrating the claim, a different TPA, and/or a different eBill agent. The Division believes that any such correspondence is sufficient. Since no other state has initiated a eBill process, this a trial and error format.
The legislature currently requires eBilling as of January 1, 2008. The Division is attempting to implement the statutory provisions in a fair and just manner. Many providers express their desire to supply the appropriate documentation so their medical bill will be paid the first time and without additional requests of information. Carriers would like to receive all documentation with the bill in order to process the bill for payment without filing a costly dispute. Furthermore, all parties would like to avoid governmental interference or dispute resolution.