At daisyNews, we write a lot about the reimbursement abuse inflicted on California workers’ comp providers. It can seem almost unbelievable how difficult it can be for providers to simply get paid for treating injured workers.

Key word: almost.

If there’s any doubt regarding how wantonly workers’ comp payment regulations are circumvented (or downright disregarded), don’t take our word for it. A medical billing service (not a daisyBill client) shared their experience with us in an email — and it echoes the experience of providers across California (and increasingly, other states):

“We have hundreds and hundreds (thousands?) of WC claims unpaid. There is not a carrier who is consistently paying authorized claims anymore.…All of them are denying saying no records attached (when they are) or that they ‘do not recognize’ the claims as theirs when it clearly is theirs. If the claims are submitted, they all deny as duplicates, even though they stated there was no claim on file or no records/auth. The entire industry has imploded with all of their workers working remotely. They have no access (or training or desire) to pay any claims. To receive payment ALL WC claims are submitted with records AND authorization, which is exhausting our manpower.”

Below, we unpack the systemic issues mentioned in the message above — and explain exactly how daisyBill utilizes technology to:

• Monitor payment denials and help providers navigate payer non-compliance
• Collect data as evidence of claims administrators non-compliance
• Submit formal Audit Complaints to the Division of Workers’ Compensation (DWC) to report noncompliance (253,471 submitted to date, and climbing)

As we’ve pointed out many, many times, there are almost zero consequences for claims administrators improperly denying bills. In fact, improper denials can be profitable, because the claims administrator keeps the reimbursement owed  if the provider fails to timely undertake any step of the appeals process.