LWP Claims Solutions, Inc.

Also known as LWP
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Contact Information
Name
LWP Claims Solutions, Inc.
Type
Third-Party Administrator
daisyBill Payer ID
db79790
Hours of Operation
08:30 AM - 04:30 PM PDT
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

1,152
Total Provider Count
4,356
Total Injury Count
22,172
Total Bill Count
10
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 *
9.7
Medical-Legal
12.1
Copy Service
8.2
Interpreter
22.1
Facility *
12.5
Pharmacy *
13

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.

87%
Official Medical Fee Schedule (OMFS)
OMFS Reimbursement Due
$2,797,861
100.0%
LWP Reimbursement Reduction
$361,955
12.9%
LWP Reduced Reimbursement
$2,435,905
87.1%

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.

$33,323
Penalty and Interest Balance Due
Total Penalty & Interest Due*
$35,191
Self-Executed Penalty & Interest Paid
$1,868
Penalty & Interest Balance Due
$33,323
Bill Transmission Year
Bill Count
EOR Receipt Count
EOR Missing Count*
Payment Late Count
Penalty Due
Interest Due
Total P&I Due
2021
890
725
81%
165
19%
76
10%
$2,100
$237
$2,337
2022
7,820
6,070
78%
1,750
22%
407
7%
$16,985
$3,445
$20,430
2023
14,180
13,591
96%
589
4%
161
1%
$7,695
$2,750
$10,445
2024
2,704
2,502
93%
202
7%
28
1%
$1,683
$296
$1,980
Total
25,594
22,888
89%
2,706
11%
672
3%
$28,463
$6,728
$35,191

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

99%
X12 837 EDI Compliant
Bill Transmission
Original Bill
Second Review Appeal
Total
X12 837 EDI Compliant
837 Compliant
15,597
99%
745
90%
16,342
99%
Yes
837 Not Accepted
120
1%
79
10%
199
1%
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.

100%
X12 277 Timeliness Compliant
Bill Transmission
Original Bill
Second Review Appeal
Total
X12 277 Timeliness Compliant
277 Timely
15,585
100%
745
100%
16,330
100%
Yes
277 Untimely
12
0%
0
0%
12
0%
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.

87%
X12 277 STC Compliant
Bill Transmission
Original Bill
Second Review Appeal
Total
X12 277 STC Compliant
STC Accept
13,376
86%
582
78%
13,958
85%
Yes
STC Reject
225
1%
0
0%
225
1%
Yes
STC Invalid - Reject Second Review
0
0%
163
22%
163
1%
No
STC Invalid - Reject Injury Claim Valid
591
4%
0
0%
591
4%
No
STC Invalid - Reject Category/Code
6
0%
0
0%
6
0%
No
STC Invalid - Reject Prior Accept
1,399
9%
0
0%
1,399
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.

82%
X12 835 Compliant
X12 EDI Standard
Original e-Bill
Second Review Appeal
Total
X12 835 Compliant
835 Compliant
11,332
85%
156
27%
11,488
82%
Yes
835 Missing
444
3%
53
9%
497
4%
No
835 Late
1,517
11%
370
64%
1,887
14%
No
835 Invalid Data
83
1%
3
1%
86
1%
No

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