Most Recent Articles

SCIF Tantrum Subverts the IBR Process

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?

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...

City of Los Angeles Neglects Its Duty

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...

Victory for Providers: Maximus Rules on CPT 99358

*Update: The 2021 OMFS updates drastically changed how E/M codes are billed. The article below only applies to DOS before March 1, 2021.*In the past, DaisyBill has rep...

Markel First/Midwest EORs Leave Providers in the Dark

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

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...

Convoluted Coding: Applied Underwriters Tries to Shortchange Provider

For anyone concerned by the lack of providers willing to treat injured workers, the following dark tale perfectly illustrates the reason so many providers flee workers’ comp....

Bill Review Highlight: Definiti Healthcare Management

Over the last several years, providers have sent over 5.2 million workers’ comp bills from daisyBill. These millions of bills allow daisyBill to directly witness the manageme...

Maximus & DWC Drop Ball on IBR Eligibility

California workers’ comp billing and payment regulations are a minefield of complications. That said, some rules are fairly simple, and should be immutable. For exampl...

York EORs Create Revenue Management Headaches

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

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...

New York & the CMS-1500: The Big Day Approaches, But When?

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 ...