Texas
Since 2008, providers and payers have been required to have the capability to receive medical bills electronically and to remit electronic payment advice. However, to ease initial compliance burdens, providers and payers have been allowed to receive eBilling waivers and to utilize various eBilling "clearinghouses" or agents. This is about to change. To push enhanced system compliance, the Texas Division of Workers' Compensation (TDWC) recently published proposed changes to existing eBilling rule requirements that:

• Remove "must be capable" (of receiving and remitting) language, replacing it with "shall submit and shall remit" language, making eBilling the exclusive format.
• Update required formats for eBilling, in anticipation of HIPAA-related changes to ANSI/ASC 837 and NCPDP (National Council for Prescription Drug Programs) formats.
• Require providers and payers to show good cause for continual eBilling waivers.
• Prohibit carriers from charging health-care providers to use closed, proprietary, or "clearinghouse" eBilling systems, thus addressing concerns of compliant providers.

The proposed changes highlight TDWC's desire to increase stakeholder eBilling compliance and push eBilling as the exclusive method of workers' compensation medical billing. It appears that in Texas, the grace period for eBilling non-compliance may be coming to an end.

Minnesota
In July 2008, Minnesota implemented phased-in eBilling requirements for all health-care providers and payers, including workers' compensation. Driven by legislative order, the Minnesota Department of Health (MNDOH) adopted ANSI/ASC and NCPDP formats for their eBilling guidelines, creating similarities between Minnesota and Texas. Despite the similarities, there are striking differences. First, implementation will happen over two phases (transmittal required July 15, 2009, and remittance required Dec. 15, 2009). Second, Minnesota requires usage of adopted standards. Most importantly, Minnesota is not granting eBilling compliance waivers. Lacking waivers, providers and payers are expected to exhibit day-one "compliance in practice." Initial enforcement efforts and agency audits will be complaint-driven.

California
As successful eBilling implementations take hold in Texas and Minnesota, California's Division of Workers' Compensation (CADWC) edges closer to publication of draft eBilling rules. In discussions with experts from CADWC, it appears the division will institute eBilling guidelines in line with those required by Texas and Minnesota and recommended by entities such as the International Association of Industrial Accident Boards and Commissions (IAIABC). California will likely recommend or require utilization of national standards similar to Minnesota and Texas. Eventually, CADWC's desire is to push eBilling as the exclusive billing format for California workers' compensation system participants. Publication and adoption of final rules are not expected until mid-2010, with an end-of-year implementation kick-off date.