Most Recent Articles

CA Appeal Denials Based on Defunct MUE Values

Last month, California’s Division of Workers’ Compensation (DWC) posted updates to the Official Medical Fee Schedule (OMFS) which included an unpleasant surprise. The OMFS ad...

Broadspire Denies Unprocessed Workers’ Comp Bills

Broadspire, a global third-party claims administrator (TPA), incorrectly denied several bills for the treatment of an injured worker. While incorrect denials are nothing new ...

CA Workers' Comp: Navigating Billing for Allianz/FFIC

Effective May 1 of this year, insurers Allianz and Fireman’s Fund Insurance Company (FFIC) merged their payment systems for California workers’ comp to reflect Allianz’s 2015...

New York Billing: CMS-1500 Field 19 (Additional Claim Information)

New York State workers’ comp billing is in transition. Ultimately, the state will make a full, mandatory switch to e-billing. But before that, starting on January 1, 2019, pr...

NY Workers' Comp Billing: How to Complete CMS 1500

Starting January 1, 2019, New York workers’ comp providers may submit original bills using the CMS 1500 form, rather than New York-specific forms C-4, C-4.2, OT/PT-4, PS-4, a...

Maximus Creates IBR Delays With Impossible Demands

Maximus Federal Services, the private entity which conducts Independent Bill Review (IBR) on behalf of California’s Division of Workers’ Compensation (DWC), has always demons...

Clearinghouses Under the Microscope: StoneRiver P2P

Most claims administrators lack the technology to process electronic bills from providers. Instead, these claims administrators rely on clearinghouses. Since DaisyBill has di...

CA Providers: Do Not Provide Additional Reports Without Payment

For California workers’ comp providers, reporting is an important (if sometimes burdensome) requirement. Documentation is everything, hence the requirements for reports like ...

New York Workers’ Comp: Big Billing Changes Coming in 2019

On April 17, 2018, the New York State Workers’ Compensation Board (WCB) announced its intention to improve medical care for injured workers. Board Bulletin Subject No. 046-10...

CA DWC Revises OMFS Update, Resolves MUE/Acupuncture Confusion

A recently adopted Medicare Medically Unlikely Edit (MUE) assigned a value of “0” to many common workers’ comp billing codes, including those for acupuncture services. Provid...

Details Matter: Always Keep Accurate Workers' Comp Bill History

When it comes to protecting your office’s revenue, maintaining detailed and accurate records is crucial. Especially when disputes over billing and payment arise, it’s often t...

OMFS Update: Reimbursement Change For Pathology and Clinical Laboratory Services

California’s Division of Workers’ Compensation (DWC) ordered an update to the Pathology and Clinical Laboratory section of the Official Medical Fee Schedule, bringing the OMF...