California workers’ comp fee schedules aren’t easy to keep up with.

Subject to constant revision, the complex formulas for calculating correct reimbursement are more than human brainpower can handle — hence the need for top-notch technology.

Recently, daisyBill alerted Third-Party Administrator (TPA) CorVel that it was incorrectly reimbursing providers for treatments rendered on or after April 1, 2024, when the rates under California’s Physician Fee Schedule increased for the second time in 2024.

Fortunately, CorVel was quick to acknowledge and correct the error. We tip our hat to this TPA for working with daisyBill to update its calculations quickly. This is how workers’ comp should work.

Unfortunately, CorVel was not the only claims administrator that erroneously reduced providers’ reimbursements. With little regulatory enforcement, claims administrators that fail to adhere to the Official Medical Fee Schedule (OMFS) face no consequences.

Providers must always check the amounts listed on Explanations of Review (EORs) against the applicable fee schedule, and submit Second Review appeals to dispute incorrect reimbursements.

daisyBill Alerts CorVel to Payment Errors

daisyBill integrates the California Physician Fee Schedule into its billing software and automatically calculates the balance due when a claims administrator fails to reimburse properly.

For dates of service on or after April 1 of this year, Physician Fee Schedule rates increased. Accordingly, daisyBill software began flagging incorrect payments that did not reflect the increase.

On April 25, daisyBill contacted CorVel about multiple incorrect reimbursements for service dates on or after April 1st. The very next day, CorVel assured daisyBill that the error had been identified and corrected. CorVel also pledged that it was “proactively correcting” any erroneous payments made at the previous, lower rates.

In the example below, GuideOne Insurance (for which CorVel reviews bills) paid the wrong amounts for treatment rendered on April 1st. Accordingly, the daisyBill screenshot below indicates a $13.02 ‘Balance Due.’

The ‘Expected Fee Schedule %’ column shows that GuideOne paid only 98% of the amount due.

CorVel Promptly Corrects Errors

We thank CorVel for their quick response and commitment to addressing the inevitable mistakes in workers’ comp billing and payment.

Again, this is how workers’ comp should work.

CorVel’s typical cooperativeness demonstrates that payers and providers need not have an antagonistic approach to correct reimbursement. With reliable technology, billing and payment can be smooth and efficient, even when errors occur.

Know exactly what you’re owed for treating injured workers. Get instant, accurate fee schedule calculations with daisyWizard’s OMFS Calculator.

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