Most Recent Articles

York Misses the Mark: Paying 2019 Bills at 2018 OMFS Rates

Not one to avoid the spotlight, York Risk Services joins Sedgwick CMS in incorrectly applying the 2018 Physician Fee Schedule rates to services rendered in 2019. Our data sho...

State Farm Workers’ Comp Claims Moved to Sedgwick CMS

Time to start counting your poultry -- State Farm’s workers’ compensation henhouse is now guarded by the third-party administrator (TPA) Sedgwick, effective October 21, 2018....

California-Specific Codes Updated for 2019

With the flurry of new year fee schedule changes, California updated the Physician Fee Schedule reimbursement for its state-specific codes. These codes are explained in 8 CCR...

Sedgwick Still Reimbursing at 2018 Rates for California

Since the beginning of 2019, Sedgwick CMS has incorrectly used the 2018 Physician Fee Schedule to reimburse providers. Our data indicates that Sedgwick is consistently and in...

2019 CA Workers’ Comp Evaluation & Management Cheat Sheet

The 2019 changes to California’s reimbursements got your head spinning? Here’s a handy reimbursement cheat sheet for the most frequently used Evaluation & Management codes.

Location-Based Adjustments (GPCIs) Now in Effect for California, as of January 1, 2019

For better or worse, location-based adjustments are here for California workers’ comp. Find out how they impact reimbursements in 2019. As our preliminary calculations...

Good-bye CPT 96101 and CPT 96102

For 2019 beloved psychological testing codes 96101 and 96102 have vanished. Effective for dates of service on or after January 1, 2019, the Medicine/Central Nervous ...

CA OMFS Inpatient Hospital Fee Schedule Update

California’s Division of Workers’ Compensation (DWC) posted an adjustment to the Inpatient Hospital section of the Official Medical Fee Schedule (OMFS), effective for dischar...

The 5 Point Checklist for CPT Codes 99358 and 99359

Changes have been made to the California OMFS since the publication of this article. Be sure to see the latest analyses here and here.2021 OMFS updates drastically cha...

CA Claims Admin Delays Payment, Skirts IBR Rules

When the Independent Bill Review (IBR) process overturns a claims administrator’s incorrect denial or adjustment, the claims administrator is legally bound to timely pay what...

CA: Optum Clearinghouse Issue Resolved

On Tuesday, October 9, Optum Property and Casualty Clearinghouse suffered a major systems issue, preventing Optum from receiving, processing, or responding to electronic bill...

CA: Employers 100% Responsible for UR Mistakes

In a much-anticipated ruling, California’s Supreme Court ruled that a secondary injury derived from an incorrect Utilization Review (UR) decision is compensable under workers...