Broadspire Pays Provider 47% Below CA OMFS
Apr 7, 2021
It happens every year: Reimbursement rates for workers’ compensation services in California change, and payers reimburse providers at the lesser, previous rates.It hap...
City and County of San Francisco's Misleading Response in PPO Discount Dispute
Apr 5, 2021
Recently, a DaisyBill provider disputed a reduction in reimbursement from the City and County of San Francisco (CCSF) for treating an injured employee. In the Explanation of ...
Broadspire Knows No Law But Its Own
Apr 2, 2021
Broadspire continues to break the rules, seemingly confident that California regulators will not hold the claims administrator to account. For months, we reported on B...
2021 Medical-Legal Cheat Sheet for CA Workers' Comp
Apr 1, 2021
It’s official: California workers’ compensation has a new Medical-Legal Fee Schedule (MLFS). Substantially different from its predecessor, the updated MLFS is effectiv...
New CA Med-Legal Fee Schedule Effective April 1
Mar 31, 2021
California’s Office of Administrative Law (OAL) issued final approval of the revamped Medical-Legal Fee Schedule (MLFS) for workers’ compensation, effective for dates of serv...
CA: New Med-Legal Fee Schedule Pending
Mar 30, 2021
A reimagined Medical-Legal Fee Schedule is on the way.Following the required public hearing and comment period, California’s Division of Workers’ Compensation (DWC) fi...
Zurich Denies Liability After Accepting Liability
Mar 30, 2021
Zurich recently denied liability for an injured workers’ treatment, claiming the 2003 injury was not work-related — despite the fact that Zurich already authorized the treatm...
CA OMFS: Physician Fee Schedule Update Effective April 1
Mar 29, 2021
California’s Division of Workers’ Compensation (DWC) issued an update to the Physician and Non-Physician Practitioner portion of the Official Medical Fee Schedule (OMFS) for ...
Zurich Delays Telehealth Reimbursement During Pandemic
Mar 26, 2021
Zurich seems committed to a policy of improperly denying reimbursement for telehealth services, during a pandemic in which remote treatment is crucial to maintaining care for...
Travelers, SCIF Incorrectly Apply New E/M Rules Before Effective Dates
Mar 25, 2021
Every year, we see claims administrators incorrectly deny reimbursement because they fail to keep up with the latest changes to the Official Medical Fee Schedule (OMFS). But ...
IBR Hall of Shame: Employers
Mar 24, 2021
Employers Holdings set a shameful new standard of indifference with regard to promptly and correctly reimbursing providers. The insurer incorrectly denied payment, disregarde...