California Insurance Guarantee Association
Also known as CIGA
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Contact Information
Name
California Insurance Guarantee Association
Type
Insurance Company
daisyBill Payer ID
db69924
Hours of Operation
07:00 AM - 04:00 PM PDT
Telephone Numbers
Main
(818) 844-4300
Main
(818) 844-4300
Bill Review
Medata Service Bureau
(800) 854-7591 x 1
CA Medical Provider Networks (MPNs)
Company Website

CIGA NATIONAL DATA

337
Total Provider Count
1,143
Total Injury Count
5,213
Total Bill Count
23
Avg Days To Pay

CIGA CALIFORNIA DATA - REIMBURSEMENT STATISTICS

CA Average Days to Pay

For each bill sent from daisyBill software to CIGA, our technology tracks the count of business days it took CIGA to process the bill.

For the listed California workers’ comp fee schedules, this table reflects the average count of business days from CIGA’s receipt of a bill until the daisyBill client received an explanation of review (EOR) and payment from CIGA.

* California requires claims administrators to pay e-bills for medical treatment within 15 working days of receipt of the e-bill.

California Workers' Comp Fee Schedule
Average Days to Pay
Medical
15.4
Medical-Legal
18.0
Interpreter
15.4
Copy Service
14.7
Facility
12

CA Official Medical Fee Schedule

The California Official Medical Fee Schedule (OMFS) establishes the reimbursement amounts due to providers for medical treatment furnished to injured workers. However, rather than reimbursing providers the reimbursement amounts due per the OMFS, CIGA uses Preferred Provider Organizations (PPOs) to reduce the reimbursements paid to providers.

For CIGA medical treatment bills, this table reflects the OMFS Reimbursement Due to daisyBill clients for medical treatment provided to injured workers. CIGA Reimbursement Reduction reflects the amount CIGA failed to pay daisyBill clients. The CIGA Reduced Reimbursement reflects the reimbursement amount CIGA ultimately reimbursed daisyBill providers.

77%
Official Medical Fee Schedule (OMFS)
OMFS Reimbursement Due
$149,914
100.0%
CIGA Reimbursement Reduction
$34,480
23.0%
CIGA Reduced Reimbursement
$115,434
77.0%

CIGA CALIFORNIA DATA - PENALTY & INTEREST

If CIGA fails to remit payment within mandated time frames, California law requires the claims administrator to “self-execute” Penalty and Interest payments directly to the provider. Often claims administrators fail to self-execute these Penalities and Interest (P&I).

Using e-billing data, daisyBill calculates the Total P&I Due to daisyBill clients and the amount of P&I CIGA reported paying our clients.

The Penalty & Interest Balance Due displayed here is the amount CIGA failed to self-execute to daisyBill clients as mandated by California law.

$64,768
Penalty and Interest Balance Due
Total Penalty & Interest Due*
$64,768
Self-Executed Penalty & Interest Paid
$0
Penalty & Interest Balance Due
$64,768
Bill Transmission Year
Bill Count
EOR Receipt Count
EOR Missing Count*
Payment Late Count
Penalty Due
Interest Due
Total P&I Due
2019
5,436
3,744
69%
1,692
31%
530
14%
$13,803
$4,716
$18,519
2020
4,926
3,159
64%
1,767
36%
466
15%
$20,393
$6,663
$27,056
2021
4,433
2,838
64%
1,595
36%
309
11%
$11,615
$2,807
$14,422
2022
1,964
1,438
73%
526
27%
180
13%
$4,427
$343
$4,771
Total
16,759
11,179
67%
5,580
33%
1,485
13%
$50,239
$14,529
$64,768

Once a bill payment is 45 calendar days overdue, daisyBill calculates Penalty and Interest amounts owed. Total P&I Due may slightly overstate the amount owed by CIGA in the instances where the underlying employer is a government employer, as California allows government employers 60 calendar days to timely reimburse workers' comp bills.

*EOR Missing Count reflects the instances where CIGA failed to electronically send the provider an EOR, therefore, daisyBill could not calculate whether P&I is due for these e-bills where the EOR is missing. Data updates daily.

CIGA CALIFORNIA DATA - EDI COMPLIANCE

Commencing October 2012, California law mandates claims administrators must accept the electronic submission of complete medical bills (‘e-bills’) from providers. For e-bills, the California Division of Workers’ Compensation (DWC) Medical Billing and Payment Guide establishes timeframes by which claims administrators (aka payers) must acknowledge, object to, pay, and provide an Explanation of Review (EOR) in response to all e-bills sent by workers’ comp providers.

Using the collective data from daisyBill clients’ e-bills, below the data reports how often CIGA both complied and failed to comply with the mandated California e-billing requirements and timeframes when processing e-bills sent by daisyBill clients.

X12 837 e-Bill Acceptance

California law requires CIGA to accept workers’ comp e-bills from providers, including accepting Second Review appeals providers send electronically.

daisyBill transmits all bills and Second Review appeals electronically to CIGA using the X12 837 EDI standard as required by DWC Rule 7.1. When CIGA fails to compliantly accept an e-bill, daisyBill uses a non-EDI method (fax, email or mail) to transmit a paper bill to CIGA for processing.

For bills submitted last quarter, the table below reports the frequency at which CIGA compliantly accepts e-bills daisyBill compliantly sent using the required X12 837 EDI standard. The table also reports the frequency at which CIGA fails to compliantly accept e-bills, thereby forcing providers to submit non-EDI paper bills to CIGA.

 To learn more, review the sample Audit Complaints daisyBill submits to the California DWC to report EDI noncompliance

100%
X12 837 EDI Compliant
Bill Transmission
Original Bill
Second Review Appeal
Total
X12 837 EDI Compliant
X12 837 EDI
831
100%
109
100%
940
100%
Yes
Non-EDI Paper Bill - Fax
2
0%
0
0%
2
0%
No

X12 277 Acknowledgement

Upon receipt of an e-bill, DWC Rule 71 requires CIGA to either accept an e-bill as complete or reject the e-bill as incomplete. Within two working days after receipt of an e-bill, CIGA must electronically send the provider a notice verifying that CIGA accepted or rejected the e-bill. DWC Rule 7.1 mandates that CIGA must send the electronic notice to providers using the X12 277 Acknowledgement (277 ACK) EDI standard.

The table below reports the frequency at which CIGA compliantly sends 277 ACK notices to daisyBill clients.

 Review the sample Audit Complaints daisyBill submits to the California DWC to report EDI noncompliance

80%
X12 277 ACK Compliant
Bill Transmission
Original Bill
Second Review Appeal
Total
X12 277 ACK Compliant
277 ACK Compliant
668
80%
87
80%
755
80%
Yes
277 ACK Compliant
4
0%
0
0%
4
0%
No
277 Late
141
17%
22
20%
163
17%
No
277 Reject Untimely / Prior 277 Accept
18
2%
0
0%
18
2%
No

X12 835 EOR

DWC Rule 7.1 requires CIGA to electronically send an Explanation of Review (EOR) to the provider using the X12 835 EDI standard. When a provider sends an Original e-bill, CIGA must electronically send the EOR within 15 working days after receipt of the e-bill from the provider. For Second Review e-bills, CIGA must electronically send the provider an EOR within 14 calendar days after receipt of the Second Reiew e-bill from the provider.

The table below reports the frequency at which CIGA compliantly sends X12 835 EORs to daisyBill clients.

 Review the sample Audit Complaints daisyBill submits to the California DWC to report EDI noncompliance.

27%
X12 835 Compliant
X12 EDI Standard
Original e-Bill
Second Review Appeal
Total
X12 835 Compliant
835 Compliant
244
30%
2
2%
246
27%
Yes
835 Missing
176
22%
38
35%
214
23%
No
835 Late
387
48%
69
63%
456
50%
No

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