ESIS, Inc.

Also known as ESIS
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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

1,865
Total Provider Count
13,759
Total Injury Count
76,627
Total Bill Count
e-Bill
Bill Delivery
5%
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 *
12.3
Interpreter
10.4
Copy Service
11.9
Medical-Legal
10.3
Facility *
14.6
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
$4,422,740
100.0%
ESIS Reimbursement Reduction
$625,461
14.1%
ESIS Reduced Reimbursement
$3,797,279
85.9%

ESIS CALIFORNIA DATA - EDI COMPLIANCE

Since October 2012, California law has mandated that claims administrators accept electronic medical bills (e-bills) and adhere to specific timeframes established by the Division of Workers’ Compensation (DWC) Medical Billing and Payment Guide. These timeframes govern the following Electronic Data Interchange (EDI) transactions:

  • 837 (e-bill) Receipt: The provider's initial submission of the electronic medical bill and subsequent Second Review appeals.

  • 277 Acknowledgement (ACK) Receipt: An electronic confirmation from the claims administrator indicating that the e-bill has been received and whether it has been accepted or rejected.​

  • 835 Explanation of Review (EOR) Receipt: A detailed electronic response from the claims administrator outlining the adjudication results of the e-bill, including payment details or reasons for denial.

By tracking this EDI data, daisyBill helps providers identify trends, resolve billing discrepancies, and maintain transparency in the workers’ comp electronic billing process.

X12 837 e-Bill Acceptance

California law requires ESIS to accept workers’ comp e-bills and Second Review appeals submitted electronically by providers. daisyBill transmits all bills and appeals using the X12 837 EDI standard, as mandated by DWC Rule 7.1.

When ESIS fails to accept e-bills compliantly, daisyBill resorts to non-EDI methods (fax, email, or mail) to submit paper bills for processing.

The table below shows how often ESIS properly accepts e-bills sent via the required X12 837 EDI standard and how often ESIS's failure forces providers to submit paper bills.

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

X12 277 Acknowledgement (ACK) - Timeliness

California requires ESIS to electronically send a 277 Acknowledgement (277 ACK) to the provider within two working days of receiving an e-bill. This notice confirms whether ESIS accepted or rejected the e-bill for payment adjudication. If the 277 ACK indicates acceptance, it serves as proof that ESIS received the e-bill for processing.

The table below shows how often ESIS sends 277 ACK notices to daisyBill clients within the required two working days after receiving an e-bill.

100%
X12 277 Timeliness Compliant
Bill Transmission
Original Bill
Second Review Appeal
Total
X12 277 Timeliness Compliant
277 Receipt 2 Working Days
41,104
100%
3,867
100%
44,971
100%
Yes
277 Receipt 3+ Working Days
5
0%
0
0%
5
0%
No

X12 277 Acknowledgement - Invalid e-Bill Rejections

daisyBill tracks the following criteria from ESIS 277 Acknowledgement (277 ACK) responses to e-bills:

277 Accept: Confirms that the e-bill was accepted for payment adjudication.

277 Reject: Indicates that the e-bill was rejected, with an associated STC Category and STC Code explaining the reason.

STC Invalid – Reject Second Review: An improper rejection of a Second Review appeal using invalid STC Category and/or STC Code.

STC Invalid – Reject Category/Code: A rejection where the STC Category and/or STC Code provided is invalid or not allowed.

STC Invalid – Reject Prior Accept: An incorrect rejection of an e-bill that was previously accepted via an earlier 277 ACK.

These criteria provide detailed insight into how often ESIS appropriately processes or improperly rejects e-bills and appeals.

91%
X12 277 STC Compliant
Bill Transmission
Original Bill
Second Review Appeal
Total
X12 277 STC Compliant
277 Accept
37,879
92%
2,875
74%
40,754
91%
Yes
277 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
617
2%
0
0%
617
1%
No
STC Invalid - Reject Category/Code
604
1%
0
0%
604
1%
No
STC Invalid - Reject Prior Accept
1,888
5%
0
0%
1,888
4%
No

X12 835 Explanation of Review

An electronic Explanation of Review (EOR) is transmitted using the X12 835 EDI standard and provides details on the adjudication of an e-bill. DWC Rule 7.1 requires ESIS to electronically send an Explanation of Review (EOR) to the provider using the X12 835 EDI standard.

For Original e-Bills, ESIS must electronically send the EOR within 15 working days after receiving the e-bill.

For Second Review Appeals, ESIS must electronically send the EOR within 14 calendar days after receiving the Second Review e-bill.

The table below shows how often ESIS sends X12 835 EORs to daisyBill clients within the required timeframes.

37%
X12 835 Compliant
X12 EDI Standard
Original e-Bill
Second Review Appeal
Total
X12 835 Compliant
835 Receipt 15 Working Days
14,824
39%
455
16%
15,279
37%
Yes
835 Missing
3,722
10%
298
10%
4,020
10%
No
835 Late
7,238
19%
825
29%
8,063
20%
No
835 Invalid Data
12,095
32%
1,297
45%
13,392
33%
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.

$847,982
Penalty and Interest Balance Due
Total Penalty & Interest Due*
$887,299
Self-Executed Penalty & Interest Paid
$39,317
Penalty & Interest Balance Due
$847,982
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%
1,672
6%
$72,554
$51,872
$124,426
2020
34,070
29,912
88%
4,158
12%
1,676
6%
$74,311
$52,578
$126,889
2021
40,272
32,983
82%
7,289
18%
2,531
8%
$133,844
$55,121
$188,964
2022
52,726
45,645
87%
7,081
13%
3,165
7%
$173,554
$41,124
$214,678
2023
53,740
43,368
81%
10,372
19%
1,755
4%
$92,085
$23,867
$115,952
2024
56,586
47,197
83%
9,389
17%
2,117
4%
$90,380
$11,738
$102,118
2025
11,865
6,828
58%
5,037
42%
438
6%
$13,517
$754
$14,272
Total
280,879
233,933
83%
46,946
17%
13,354
6%
$650,245
$237,054
$887,299

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.

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