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ML201 - AmTrust North America: Grade F

ML201 - AmTrust North America: Grade F

Claims administrator failed to properly reimburse ML201. AmTrust incorrectly re-coded ML201 to ML102. Date of Service: 04/13/2021

MLFS Code(s)

ML201 - Comprehensive Medical-Legal Evaluation

MLFS Modifier(s)

95 - Evaluation performed by a panel selected Qualified Medical Evaluator

MLFS Grade

F

Claims Administrator

AmTrust North America

Bill Review Vendor

Mitchell International

Employer

OC Dough Inc

EOR Adjustment Reason

270 - No allowance has been recommended for this procedure/service/supply.

Second Review Reason to dispute incorrect reimbursement

Claims administrator incorrectly re-coded ML201 to ML102 and denied reimbursement. Per CCR §9795, ML201 is valid reimbursable procedure code that includes all comprehensive medical-legal evaluations that do not qualify as follow-up or supplemental medical- legal evaluations. Provider conducted a Comprehensive Medical-Legal Evaluation at the request of the parties. ML201-95 payment due: $2,015.00. In addition to payment, penalties and interest are now due.


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