York EORs Create Revenue Management Headaches
Oct 17, 2019
York Insurance has repeatedly reported incorrect payment amounts in recent Final Explanations of Review (EORs), which are issued in response to second review appeals. These F...
Farmers Insurance Switches Bill Review
Oct 16, 2019
Effective October 14, Farmers Insurance switched bill review services, from CorVel to Mitchell.This change affects bills for all dates of service. Claim numbers remain...
SB 537: California RFA and Utilization Review Data
Oct 15, 2019
Last week Gavin Newsom, who serves as Governor of California, signed SB 537 into law, thereby adding a new section 138.8 to the Labor Code. This new §138.8 requires the Depar...
New York & the CMS-1500: The Big Day Approaches, But When?
Oct 15, 2019
The New York State Workers’ Compensation Board (WCB) is in love. The regulatory body fell hard for the CMS-1500 (sometimes called a ‘HCFA’), and is currently moving toward a ...
CA OMFS: Physician Services Fee Schedule Update Effective 10/1/2019
Oct 15, 2019
A new order from the Administrative Director of California’s Division of Workers’ Compensation (DWC) updates the Physician and Non-Physician Practitioner Services portion of ...
The Zenith Unsucessfully Attempts to Undermine IBR Request
Oct 14, 2019
Claims administrators continue to innovate new techniques that make it harder for providers to receive proper reimbursement. In this installment, we tell a tale of the length...
CA OMFS: DMEPOS Fee Schedule Update Effective 10/1/2019
Oct 10, 2019
In Newsline No.: 2019-75, the California Division of Workers’ Compensation (DWC) announced updates to the Official Medical Fee Schedule for Durable Medical Equipment, Prosthe...
Audit Complaint Form Updated in California
Oct 9, 2019
Recently the California Division of Workers Compensation (DWC) updated the Audit Complaint form used by providers to report claims administrator non-compliance. The up...
CA OMFS: Pathology/Clinical Lab Fee Schedule Update Effective 10/1/2019
Oct 8, 2019
On October 4, 2019, California’s Division of Workers’ Compensation (DWC) ordered an update to the Pathology and Clinical Laboratory section of the Official Medical Fee Schedu...
Liberty Mutual and a Cautionary Tale of Payment Woes
Oct 3, 2019
Today we’re sharing a maddening and all-too-common story of payment woes, this time featuring Liberty Mutual as the miscreant that just won’t pay a bill correctly -- despite ...
Huntington Hospital & City of Beverly Hills Change TPAs
Sep 20, 2019
Attention providers: two California employers switched third-party administrators (TPAs).Huntington Hospital transferred claims from Sedgwick to AthensCity of B...
York (aka Sedgwick) Fails Math: EORs Literally Don't Add Up
Sep 19, 2019
York Risk Services, which was acquired this month by Sedgwick, has significant math troubles. York recently returned Explanations of Review (EORs) which obfuscated the effect...