Most Recent Articles
Nov 2, 2022
Gallagher Bassett: False MPN Denial
In yet another instance of a claims administrator improperly denying payment because the provider was (allegedly) not a member of the applicable Medical Provider Network (MPN...
Nov 2, 2022
Employers Insurance: False MPN Payment Denial
California allows insurers and self-insured employers to establish Medical Provider Networks (MPNs) to direct injured workers’ care. While Employers Preferred Insurance Compa...
Nov 2, 2022
Sedgwick Stiffs QME With False MPN Denial (Again)
It’s been said that insanity is best defined by doing the same thing repeatedly, but expecting different results. If that’s the case, Sedgwick Claims Management Services has ...
Nov 2, 2022
MPNs: How to Detect Dubious Payment Denials
In California workers’ comp, one of the biggest — but least talked about — challenges for providers is navigating the Medical Provider Network (MPN) system. MPNs were ...
Oct 13, 2022
How "Fast-Track" UR Can Backfire for CA Providers
California’s “Fast-Track” Utilization Review (UR) initially sounded like good news for doctors who provide the first treatment following a work-related injury. ...
Oct 13, 2022
CA MPN List Updates Q4 2022
The California Division of Workers’ Comp (DWC) updated its list of Medical Provider Networks (MPNs). The DWC update:Added 2 new MPNsApproved 3 previously suspen...
Oct 13, 2022
New York: WCB Update Affirms Electronic EOR Requirement
New York State’s Workers’ Compensation Board (WCB) issued an update to the mandatory Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) required...
Oct 13, 2022
New York: How to Guarantee e-Bills Reach Payers
For New York State providers, electronic billing is the best way to make treating injured workers financially sustainable. But to e-bill successfully requires the provider’s ...
Oct 6, 2022
DWC Proposes More Time to Schedule QME Appointment
California’s Division of Workers’ Compensation (DWC) will hold a public hearing on significant proposed changes to the regulations governing Medical-Legal evaluations.
Oct 6, 2022
CA OMFS Update: Physician Fee Schedule - Q4 2022
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 ...
Oct 6, 2022
Practice Recovers $1 Million Annually via Second Review Appeals
It’s official: daisyBill providers have recovered over $100 million in revenue by electronically submitting Second Review appeals to dispute incorrect reimbursements f...
Oct 4, 2022
WCIRB Report Obscures CA Workers' Comp's Real Challenges
A report from the Workers’ Compensation Insurance Rating Bureau (WCIRB) of California asserts that in 2021, “overall medical payments per claim increased significantly.” Howe...