Most Recent Articles

CA Pharmaceutical Fee File Corrected

Providers, take note: California’s Division of Workers’ Compensation (DWC) announced that the Medi-Cal pharmaceutical fee data file, updated weekly, was replaced for the week...

CA: Location-Based Adjustments Set to Take Effect in 2019

In April, the California Division of Workers’ Compensation (DWC) held a hearing regarding the inclusion of the Medicare Geographic Practice Cost Indices (GPCI) in the Physici...

CA Claims Admins Fail to Comply With 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 Pathology/Clinical Laboratory Billing: NCCI Edits Do Not Apply

Medicare’s National Correct Coding Initiative (NCCI) complicates California workers’ comp billing, to say the least. NCCI edits are the source of much confusion, as pr...

Data: Excessive Workers’ Comp Claim Denials Backfire

An industry study tells an interesting story about workers’ compensation claims. A significant upward trend in denials ultimately cost employers and their claims administrato...

Don't Rely on Claims Administrators. Providers Must Know The Rules.

Repeatedly, we hear some version or another of the same story: a provider reaches out to a claims administrator for information regarding workers’ comp billing and payment. T...

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...