ML200 - AIG Claims Inc.: Grade F

ML200 - AIG Claims Inc.: Grade F

Claims administrator failed to properly reimburse ML200. AIG incorrectly re-coded ML200 to 99199. Date of Service: 04/02/2021

MLFS Code(s)

ML200 - Missed Appointment for a Comprehensive or Follow-Up Medical-Legal Evaluation

MLFS Modifier(s)

95 - Evaluation performed by a panel selected Qualified Medical Evaluator

MLFS Grade

F

Claims Administrator

AIG Claims, Inc.

Bill Review Vendor

AIG Claims, Inc.

Employer

J.C. Penney Corporation, Inc.

EOR

Adjustment Reason

2 - This charge will be re-evaluated upon receipt of the proper procedure codes or procedure code/modifier combination as listed in the fee schedule.        

Second Review Reason to dispute incorrect reimbursement

Claims administrator incorrectly denied reimbursement. Per CCR §9795, ML200 is a valid code with a Relative Value of 31. Missed appointments are reimbursable when the injured worker fails to appear for the evaluation appointment. ML200 payment due: $503.75. In addition to payment, penalties and interest are now due.


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