ESIS, Inc.

Also known as ESIS
Information not right? Contact Information or Bill Review incorrect? Let us know!
Contact Information
Name
ESIS, Inc.
Type
TPA
daisyBill Payer ID
db79045
Hours of Operation
08:00 AM - 05:00 PM PDT
Telephone Numbers
Main
(800) 654-5374
Main
(800) 654-5374
Bill Review
Genex Services, Inc.
(800) 822-6099 x 1
ESIS MedBill Impact
(855) 219-1964
Conduent (formerly Bunch Care Solutions, LLC)
(866) 851-7739
CA Medical Provider Networks (MPNs)
Company Website

ESIS NATIONAL DATA

1,848
Total Provider Count
13,765
Total Injury Count
76,318
Total Bill Count
e-Bill
Bill Delivery
4%
Duplicate Bill %
11
Avg Days To Pay

ESIS CALIFORNIA DATA - REIMBURSEMENT STATISTICS

CA Average Days to Pay

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

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

* 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 *
12.1
Interpreter
10.3
Copy Service
11.9
Medical-Legal
10.2
Facility *
14.8
Pharmacy *
7.9

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

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

86%
Official Medical Fee Schedule (OMFS)
OMFS Reimbursement Due
$4,367,719
100.0%
ESIS Reimbursement Reduction
$617,692
14.1%
ESIS Reduced Reimbursement
$3,750,026
85.9%

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

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

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

95%
X12 837 EDI Compliant
Bill Transmission
Original Bill
Second Review Appeal
Total
X12 837 EDI Compliant
837 Compliant
41,109
97%
3,867
80%
44,976
95%
Yes
837 Not Accepted
1,382
3%
977
20%
2,359
5%
No

X12 277 Acknowledgement - Timeliness

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

The table below reports how often ESIS 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
41,104
100%
3,867
100%
44,971
100%
Yes
277 Untimely
5
0%
0
0%
5
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 ESIS 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, ESIS 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.

91%
X12 277 STC Compliant
Bill Transmission
Original Bill
Second Review Appeal
Total
X12 277 STC Compliant
STC Accept
37,880
92%
2,875
74%
40,755
91%
Yes
STC Reject
121
0%
0
0%
121
0%
Yes
STC Invalid - Reject Second Review
0
0%
992
26%
992
2%
No
STC Invalid - Reject Injury Claim Valid
609
1%
0
0%
609
1%
No
STC Invalid - Reject Category/Code
604
1%
0
0%
604
1%
No
STC Invalid - Reject Prior Accept
1,895
5%
0
0%
1,895
4%
No

X12 835 e-EOR

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

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

37%
X12 835 Compliant
X12 EDI Standard
Original e-Bill
Second Review Appeal
Total
X12 835 Compliant
835 Compliant
14,824
39%
455
16%
15,279
37%
Yes
835 Missing
4,529
12%
369
13%
4,898
12%
No
835 Late
6,780
18%
780
27%
7,560
19%
No
835 Invalid Data
11,747
31%
1,271
44%
13,018
32%
No

ESIS CALIFORNIA DATA - PENALTY & INTEREST

If ESIS 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 ESIS reported paying our clients.

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

$835,784
Penalty and Interest Balance Due
Total Penalty & Interest Due*
$871,745
Self-Executed Penalty & Interest Paid
$35,961
Penalty & Interest Balance Due
$835,784
Bill Transmission Year
Bill Count
EOR Receipt Count
EOR Missing Count*
Payment Late Count
Penalty Due
Interest Due
Total P&I Due
2019
31,620
28,000
89%
3,620
11%
1,671
6%
$72,547
$51,845
$124,391
2020
34,070
29,912
88%
4,158
12%
1,673
6%
$73,388
$49,511
$122,900
2021
40,272
32,981
82%
7,291
18%
2,529
8%
$133,679
$54,707
$188,386
2022
52,726
45,644
87%
7,082
13%
3,153
7%
$172,832
$39,845
$212,677
2023
53,740
43,366
81%
10,374
19%
1,746
4%
$91,773
$23,494
$115,267
2024
56,586
47,148
83%
9,438
17%
2,085
4%
$88,667
$11,244
$99,910
2025
8,950
4,937
55%
4,013
45%
258
5%
$7,716
$497
$8,214
Total
277,964
231,988
83%
45,976
17%
13,115
6%
$640,602
$231,143
$871,745

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 ESIS 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 ESIS 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.

Although daisyBill makes every effort to ensure our information is accurate, we assume no responsibility or liability for any errors or omissions in the content of this site, directory, or blog. The information contained in this site is provided on an "as is" basis with no guarantees of completeness, accuracy, usefulness or timeliness. All data on this website is subject to change without notice to improve function, reliability, design, or otherwise. Visitors to this website should take all steps necessary to ascertain that information you receive from this website is correct and has been verified.