LWP Claims Solutions
Also known as LWP
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Contact Information
Name
LWP Claims Solutions
Type
Third-Party Administrator
daisyBill Payer ID
db79790
Hours of Operation
08:30 AM - 04:30 PM PST
Telephone Numbers
Main
(916) 609-3600
Main
(916) 609-3600
Bill Review
accuro Solutions
(877) 222-8616 x 3
CA Medical Provider Networks (MPNs)
Company Website

LWP NATIONAL DATA

1,010
Total Provider Count
2,877
Total Injury Count
15,780
Total Bill Count
15
Avg Days To Pay

LWP CALIFORNIA DATA - REIMBURSEMENT STATISTICS

CA Average Days to Pay

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

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

* 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 *
16.4
Medical-Legal
18.5
Copy Service
15.2
Interpreter
24.9
Facility *
17.6
Pharmacy *
9

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, LWP uses Preferred Provider Organizations (PPOs) to reduce the reimbursements paid to providers.

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

86%
Official Medical Fee Schedule (OMFS)
OMFS Reimbursement Due
$418,061
100.0%
LWP Reimbursement Reduction
$56,977
13.6%
LWP Reduced Reimbursement
$361,084
86.4%

LWP CALIFORNIA DATA - PENALTY & INTEREST

If LWP 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 LWP reported paying our clients.

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

$19,484
Penalty and Interest Balance Due
Total Penalty & Interest Due*
$20,176
Self-Executed Penalty & Interest Paid
$692
Penalty & Interest Balance Due
$19,484
Bill Transmission Year
Bill Count
EOR Receipt Count
EOR Missing Count*
Payment Late Count
Penalty Due
Interest Due
Total P&I Due
2021
890
721
81%
169
19%
76
11%
$2,100
$237
$2,337
2022
7,817
7,143
91%
674
9%
2,720
38%
$16,394
$1,410
$17,804
2023
152
145
95%
7
5%
2
1%
$31
$4
$34
Total
8,859
8,009
90%
850
10%
2,798
35%
$18,525
$1,651
$20,176

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 LWP 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 LWP 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.

LWP 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 LWP 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 LWP 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 LWP using the X12 837 EDI standard as required by DWC Rule 7.1. When LWP fails to compliantly accept an e-bill, daisyBill uses a non-EDI method (fax, email or mail) to transmit a paper bill to LWP for processing.

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

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

83%
X12 837 EDI Compliant
Bill Transmission
Original Bill
Second Review Appeal
Total
X12 837 EDI Compliant
837 Compliant
10,191
83%
391
84%
10,582
83%
Yes
837 Not Accepted
2,061
17%
76
16%
2,137
17%
No

X12 277 Acknowledgement - Timeliness

Within two working days after receipt of an e-bill, LWP must electronically send the provider a X12 277 Acknowledgement (277 ACK) verifying that LWP either accepted or rejected the e-bill for payment adjudication. Upon receipt of a 277 ACK that accepts an e-bill, the provider has proof that LWP received the e-bill for processing.

The table below reports how often LWP compliantly sends 277 ACK notices to daisyBill clients within two working days of receipt of the e-bill.

 Review the sample Audit Complaints daisyBill submits to the California DWC to report EDI non-compliance.

95%
X12 277 Timeliness Compliant
Bill Transmission
Original Bill
Second Review Appeal
Total
X12 277 Timeliness Compliant
277 Timely
9,684
95%
347
89%
10,031
95%
Yes
277 Missing
28
0%
2
1%
30
0%
No
277 Untimely
479
5%
42
11%
521
5%
No

X12 277 Acknowledgement - Invalid e-Bill Rejections

For rejected e-bills, the 277 ACK includes STC segments with a Claim Status Category Code (STC Category) and a Claim Status Code (STC Code) explaining the reason for the e-bill rejection. The DWC allows claims administrators to reject e-bills only for a strictly defined set of (mostly technical) reasons. A 277 ACK cannot function as an electronic Explanation of Review (e-EOR) to deny payment. 

The table below lists the instances where LWP sent 277 ACKs with invalid STC Category and STC Codes that non-compliantly rejected e-bills for reasons other than allowed by the DWC. Rather than properly returning electronic Explanations of Review (e-EORs) explaining reasons for payment denial, LWP non-compliantly rejected the e-bills with improper STC Category and Codes.

 Review the sample Audit Complaints daisyBill submits to the California DWC to report EDI non-compliance.

73%
X12 277 STC Compliant
Bill Transmission
Original Bill
Second Review Appeal
Total
X12 277 STC Compliant
STC Accept
7,358
72%
274
70%
7,632
72%
Yes
STC Reject
67
1%
0
0%
67
1%
Yes
STC N/A (277 Missing)
28
0%
2
1%
30
0%
Yes
STC Invalid - Reject Second Review
0
0%
115
29%
115
1%
No
STC Invalid - Reject Injury Claim Valid
1,350
13%
0
0%
1,350
13%
No
STC Invalid - Reject Category/Code
437
4%
0
0%
437
4%
No
STC Invalid - Reject Prior Accept
951
9%
0
0%
951
9%
No

X12 835 EOR

DWC Rule 7.1 requires LWP 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, LWP must electronically send the EOR within 15 working days after receipt of the e-bill from the provider. For Second Review e-bills, LWP 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 LWP compliantly sends X12 835 EORs to daisyBill clients.

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

14%
X12 835 Compliant
X12 EDI Standard
Original e-Bill
Second Review Appeal
Total
X12 835 Compliant
835 Compliant
1,076
15%
7
3%
1,083
14%
Yes
835 Missing
1,312
18%
70
26%
1,382
18%
No
835 Late
953
13%
88
32%
1,041
14%
No
835 Invalid Data
4,017
55%
109
40%
4,126
54%
No

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