Gallagher Bassett, one of the largest Third-Party Administrators (TPAs) in the country, and its vendor, JPMorgan, may be derailing California providers' legitimate requests for Independent Bill Review (IBR) to resolve payment disputes.

Whether due to ignorance of California's workers' comp payment requirements or outright disregard for them, this TPA and its vendor have potentially cut off a California provider's only legal path to challenge an incorrect reimbursement.

daisyNews readers already know about “IBR Chicken”, the cynical game in which payers repeatedly refuse to correctly reimburse providers' bills, forcing providers to pay $195 to request IBR. Maximus (the state's independent reviewer) has acknowledged that nothing in California's regulations stops payers from playing this game.

Now, Gallagher Bassett and JPMorgan may have found a new way to tilt the game in their favor: don't give the provider the documents required to play.

Call it IBR Chicken 2.0. The payer denies the correct reimbursement and doesn’t send the provider a compliant Explanation of Review (EOR), which California requires the provider to submit with an $195 IBR request. The provider can't produce an EOR that doesn't exist; Maximus can't rule on a dispute it can't legally take up.

In effect, the payer makes IBR the provider's only option, but makes it impossible for the provider to satisfy the IBR documentation requirements to dispute an incorrect payment.

With this new twist on an old game, Gallagher Bassett and JPMorgan may have shown other payers how to take IBR Chicken to the next level.

IBR Chicken 2.0 Explained

To understand how IBR Chicken 2.0 works, it helps to first understand the vendor chain funded by employers’ workers’ comp premiums.

Gallagher Bassett is the TPA handling claims on behalf of the employer or its workers’ comp insurer. Under California law, the TPA is legally responsible for accepting e-bills from providers, properly reimbursing providers, and issuing compliant EORs. To handle those e-bills, Gallagher Bassett uses Jopari, a clearinghouse that partners with JPMorgan to deliver payments through JPMorgan's InstaMed platform.

Four entities are in play, but only one is legally responsible for adhering to the payment requirements: Gallagher Bassett.

Here’s the new dimension to IBR Chicken. In communications with daisyBill, a Jopari representative reported that providers are automatically enrolled into the JPMorgan InstaMed system for their workers' comp payments. That auto-enrollment is the foundation of the IBR Chicken 2.0 trap.

Once the provider is signed up with InstaMed, the payment documents on that platform may be the only ones available to them. In violation of California law, the provider may never receive a compliant EOR, not from Gallagher Bassett, Jopari, or JPMorgan.

How a CA Provider Got Caught Up in IBR Chicken 2.0

Here’s how the trap played out for one California provider.

After Gallagher Bassett failed to properly reimburse the provider for both the original bill and the subsequent Second Review appeal, the provider paid $195 to request IBR to resolve the payment dispute.

To request IBR, California requires a provider to submit the final EOR that the payer sent the provider in response to the Second Review appeal. However, Gallagher Bassett never sent the provider a final EOR, nor did it send an electronic Explanation of Review (e-EOR), which is mandatory for electronically submitted bills and appeals under California regulations.

Instead, the only payment documentation available to the provider was a non-compliant PDF document buried behind a login on the JPMorgan InstaMed portal (yep, the portal included in the payment system Jopari reported auto-enrolling providers into).

With no other option, the provider included the InstaMed PDF in the IBR request. Maximus refused to accept the InstaMed PDF as a valid EOR, giving the provider 10 days to furnish an EOR.

By outsourcing its payment obligations to a vendor chain that auto-enrolls worker comp providers and then fails to produce compliant EORs, Gallagher Bassett effectively made it impossible for the provider to dispute its incorrect reimbursement.

Maximus: "This Is Not an EOR"

In response to the provider's IBR request, Maximus sent the letter below to the provider explaining that the InstaMed document the provider submitted as the Final EOR "appears to be an account/claim information printout" rather than a valid EOR.

To dispute Gallagher Bassett’s incorrect payment, Maximus instructed the provider to submit "the Final EOR received in response to the SBR [Second Bill Review]" within ten days.

However, the provider did not receive a Final EOR from Gallagher Bassett.

The JPMorgan InstaMed "EOR"

Put another way: J.P. Morgan's InstaMed platform is failing to provide the information California requires the payer to share with the provider in order to contest that payer’s incorrect reimbursement.

That is the shape of a system designed to frustrate providers out of disputing anything.

Provider Compliance Punished; Payer Non-Compliance Rewarded?

To recap, the provider did everything right, in strict accordance with California law, regulations, and the MBPG. The provider:

1. Submitted a timely and compliant e-bill
2. Submitted a timely and compliant Second Review appeal electronically
3. Submitted a timely and compliant IBR request (other than J.P. Morgan's faulty "EOR," which the provider could not possibly fix)

Meanwhile, Gallagher Bassett and its merry band of feckless vendors committed multiple missteps and errors, including:

1. Automatically enrolling the provider into InstaMed payments
2. Failing to pay the original bill correctly
3. Failing to remit an e-EOR in response to the provider's electronic Second Review appeal
4. Failing to remit any usable EOR (even in paper format) in response to the Second Review appeal
5. Only making available a non-compliant InstaMed portal printout that misidentifies the payer

And yet, due to Gallagher Bassett’s failures, Maximus cannot proceed with IBR unless the provider can provide a proper Final EOR. This is not a bureaucratic quirk. It is the predictable outcome of a system in which:

• Payers face no meaningful consequences for ignoring e-EOR mandates, EOR content requirements, or correct reimbursement obligations.

It’s also an escalation to IBR Chicken 2.0. In standard IBR Chicken, the payer simply waits out the provider, betting that the $195 filing fee and the paperwork burden will make the dispute go away. In the Gallagher Bassett / Jopari / JPMorgan version, the payer effectively precludes IBR by ignoring California payment requirements.

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