Most Recent Articles

York EORs Create Revenue Management Headaches

York Insurance has repeatedly reported incorrect payment amounts in recent Final Explanations of Review (EORs), which are issued in response to second review appeals. These F...

Farmers Insurance Switches Bill Review

Effective October 14, Farmers Insurance switched bill review services, from CorVel to Mitchell.This change affects bills for all dates of service. Claim numbers remain...

New York & the CMS-1500: The Big Day Approaches, But When?

The New York State Workers’ Compensation Board (WCB) is in love. The regulatory body fell hard for the CMS-1500 (sometimes called a ‘HCFA’), and is currently moving toward a ...

SB 537: California RFA and Utilization Review Data

Last week Gavin Newsom, who serves as Governor of California, signed SB 537 into law, thereby adding a new section 138.8 to the Labor Code. This new §138.8 requires the Depar...

CA OMFS: Physician Services Fee Schedule Update Effective 10/1/2019

A new order from the Administrative Director of California’s Division of Workers’ Compensation (DWC) updates the Physician and Non-Physician Practitioner Services portion of ...

The Zenith Unsucessfully Attempts to Undermine IBR Request

Claims administrators continue to innovate new techniques that make it harder for providers to receive proper reimbursement. In this installment, we tell a tale of the length...

CA OMFS: DMEPOS Fee Schedule Update Effective 10/1/2019

In Newsline No.: 2019-75, the California Division of Workers’ Compensation (DWC) announced updates to the Official Medical Fee Schedule for Durable Medical Equipment, Prosthe...

Audit Complaint Form Updated in California

Recently the California Division of Workers Compensation (DWC) updated the Audit Complaint form used by providers to report claims administrator non-compliance. The up...

CA OMFS: Pathology/Clinical Lab Fee Schedule Update Effective 10/1/2019

On October 4, 2019, California’s Division of Workers’ Compensation (DWC) ordered an update to the Pathology and Clinical Laboratory section of the Official Medical Fee Schedu...

Liberty Mutual and a Cautionary Tale of Payment Woes

Today we’re sharing a maddening and all-too-common story of payment woes, this time featuring Liberty Mutual as the miscreant that just won’t pay a bill correctly -- despite ...

Huntington Hospital & City of Beverly Hills Change TPAs

Attention providers: two California employers switched third-party administrators (TPAs).Huntington Hospital transferred claims from Sedgwick to AthensCity of B...

York (aka Sedgwick) Fails Math: EORs Literally Don't Add Up

York Risk Services, which was acquired this month by Sedgwick, has significant math troubles. York recently returned Explanations of Review (EORs) which obfuscated the effect...