Alert: DWC Retroactively Updates CA OMFS
Feb 3, 2020
Last Thursday, January 30, 2020, the California Division of Workers’ Comp (DWC) released a retroactive change to the 2020 Physician Fee Schedule. Announced in Newsline #2020-...
Sedgwick – IBR Hall of Shame
Jan 17, 2020
All too often, insurance companies and claims administrators find unfair ways to deny, delay, and otherwise wiggle out of paying the workers’ compensation reimbursements that...
2020 CA Workers’ Comp Evaluation & Management Cheat Sheet
Jan 13, 2020
Hooray! In 2020 reimbursements increased across the board for Evaluation & Management (E&M) codes!Below we’ve compiled a nifty reimbursement cheat sheet for the seven ...
STRONG WARNING! Travelers Refuses to Pay Provider
Dec 5, 2019
We advise providers to think carefully before treating injured workers covered by Travelers. Below, we summarize the nightmarish run-around that an MPN provider experienced w...
CA Interpreters: No Second Review = No Payment
Dec 2, 2019
Providers — interpreters in particular — be advised: a California appeals court ruled that claims administrator Meadowbrook Insurance is not required to pay a disputed fee fo...
Sally Beauty Holdings: Changes TPA and Claim Numbers
Nov 26, 2019
Sally Beauty Holdings no longer uses CorVel as its third-party administrator (TPA).Effective November 15, 2019, Broadspire administers all claims for Sally Beauty Hold...
SCIF Tantrum Subverts the IBR Process
Nov 25, 2019
Few behaviors induce more cynicism than when claims administrators ask providers to withdraw requests for Independent Bill Review (IBR) in exchange for correct payment. Appar...
Hanover –> What the H*llover is Going On?
Nov 21, 2019
We have yet another tale of a payer flagrantly ignoring its duty to compliantly process provider bills for treatment of injured workers. This account of payer friction highli...
CPT 99358 - Maximus Correctly Rules in Favor of Provider (Hurray!)
Nov 18, 2019
In the past, DaisyBill has reported on many, many problems with Maximus Independent Bill Review (IBR) decisions for CPT code 99358. Today, we happily report that Maximus is n...
City of Los Angeles Neglects Its Duty
Nov 14, 2019
The City of Los Angeles (LA) is a self-insured, self-administered employer. This means that the city assumes all of the responsibilities of a claims administrator to complian...
Markel First/Midwest EORs Leave Providers in the Dark
Nov 12, 2019
Electronic Explanations of Review (EORs) from Markel First and Midwest Insurance are missing crucial pieces of information. Key required elements like patient names and Socia...
Liberty Mutual Sued by Employer
Nov 6, 2019
According to a federal lawsuit filed in October, Liberty Mutual Insurance may be playing its workers’ comp cards a little too close to the chest.The lawsuit, Valley Co...