Municipal Pooling Authority (CA)

Also known as MPA
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Contact Information
Name
Municipal Pooling Authority (CA)
Type
Joint Power Authority
daisyBill Payer ID
db92785
Hours of Operation
07:30 AM - 04:30 PM PDT
Telephone Numbers
Main
(925) 482-0013
Main
(925) 482-0013
Bill Review
Genex Services, Inc.
(800) 240-0809
CA Medical Provider Networks (MPNs)
Company Website

MPA NATIONAL DATA

76
Total Provider Count
132
Total Injury Count
874
Total Bill Count
15
Avg Days To Pay

MPA CALIFORNIA DATA - REIMBURSEMENT STATISTICS

CA Average Days to Pay

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

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

* 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 *
15.6
Medical-Legal
14.5
Facility *
24

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

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

98%
Official Medical Fee Schedule (OMFS)
OMFS Reimbursement Due
$46,686
100.0%
MPA Reimbursement Reduction
$721
1.5%
MPA Reduced Reimbursement
$45,965
98.5%

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

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

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

98%
X12 837 EDI Compliant
Bill Transmission
Original Bill
Second Review Appeal
Total
X12 837 EDI Compliant
837 Compliant
623
99%
100
92%
723
98%
Yes
837 Not Accepted
6
1%
9
8%
15
2%
No

X12 277 Acknowledgement - Timeliness

Within two working days after receipt of an e-bill, MPA must electronically send the provider a X12 277 Acknowledgement (277 ACK) verifying that MPA 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 MPA received the e-bill for processing.

The table below reports how often MPA 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
623
100%
100
100%
723
100%
Yes

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 MPA 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, MPA 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.

97%
X12 277 STC Compliant
Bill Transmission
Original Bill
Second Review Appeal
Total
X12 277 STC Compliant
STC Accept
611
98%
91
91%
702
97%
Yes
STC Invalid - Reject Second Review
0
0%
9
9%
9
1%
No
STC Invalid - Reject Injury Claim Valid
12
2%
0
0%
12
2%
No

X12 835 EOR

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

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

11%
X12 835 Compliant
X12 EDI Standard
Original e-Bill
Second Review Appeal
Total
X12 835 Compliant
835 Compliant
47
8%
33
36%
80
11%
Yes
835 Missing
101
17%
15
16%
116
17%
No
835 Late
134
22%
7
8%
141
20%
No
835 Invalid Data
329
54%
36
40%
365
52%
No

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