Most Recent Articles

Anthem/SCIF: MPN Kickback Scheme?

Healthcare software firm CareCloud recently agreed to a $3.8 million settlement, in part to resolve allegations that it traded unlawful payments for referrals, in violation o...

Athens Must Stop Taking Unnamed PPO Discounts

As advocates for a fair and just workers’ comp system, we here at DaisyBill feel compelled to remind insurer Athens Administrators of an important fact about California worke...

CCSF Stands Up On Behalf of Providers

Many payers delegate bill review to an outside entity, trusting the bill review vendor to properly reimburse providers. But when a provider disputes a denial or adjustment, i...

Prime Health: Unsigned Contract Tale Continues

Almost immediately after DaisyBill called out Prime Health Services (PHS) for questionable PPO practices, it was clear we struck a nerve. PHS attorneys sent DaisyBill a ‘plea...

California MPNs: Camouflage for Discounts and Denials

Medical Provider Networks (MPNs) are under fire — as they should be.Far too often, Calforina claims administrators (aka ‘payers’) use MPNs — and providers’ unfamiliari...

Payola? SCIF / Anthem Coordinate Provider MPN Shakedown

State Compensation Insurance Fund (SCIF) and Anthem Blue Cross (Anthem) have hacked the Medical Provider Network (MPN) system to apparently shake down providers. A recent ema...

Mob Rule: SCIF/Anthem Hold Patient(s) Hostage

On paper, Medical Provider Networks (MPNs) are a simple workers’ comp quality/cost-control measure. Employers designate an MPN, and injured workers choose from among the MPN ...

Provider Warning: Prime Health Services (Part II)

Prime Health Services (PHS) provided an unbelievable example of just how far PHS will go to secure unearned PPO discounts for their “clients”, including producing a missing s...

Provider Warning: Prime Health Services (Part I)

Recently, a provider made the unfortunate mistake of signing a Prime Health Services (PHS) Preferred Provider Agreement contract, commonly known as a PPO agreement. While not...

2021 CA Med-Legal Billing Codes Pocket Guide

California has a new Medical-Legal Fee Schedule (MLFS), effective April 1. To help medical-legal evaluators and their staff navigate these (drastic) changes, we created a dow...

Broadspire Pays Provider 47% Below CA OMFS

It happens every year: Reimbursement rates for workers’ compensation services in California change, and payers reimburse providers at the lesser, previous rates.It hap...

City & County of San Francisco's Misleading Reply in PPO Dispute

Recently, a DaisyBill provider disputed a reduction in reimbursement from the City and County of San Francisco (CCSF) for treating an injured employee. In the Explanation of ...