eBilling and State Reporting - Are You Prepared?

Nudging the workers’ compensation marketplace into the twenty-first century, state regulators have either moved forward with or are developing mandates for electronic reporting of medical claims data. Given activity in three key states, it appears that eBilling requirements are next on the project list. However, while electronic reporting and eBilling are intended to streamline and update the system, they both present challenges and opportunities. Recent eBilling policy enhancements in Minnesota, Texas, and California offer a glimpse of how eBilling in particular continues to evolve.

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: