ML201 - Guard Insurance Group: Grade F
Claims administrator failed to properly reimburse ML201. Guard incorrectly incorrectly reduced reimbursement by taking a noncompliant PPO reduction. Date of Service: 04/17/2021
MLFS Code(s) |
ML201 - Comprehensive Medical-Legal Evaluation |
MLFS Modifier(s) |
93 - Interpreter needed at time of examination 95 - Evaluation performed by a panel selected Qualified Medical Evaluator |
MLFS Grade |
F |
Claims Administrator |
Guard Insurance Group |
Bill Review Vendor |
Guard Insurance Group |
Employer |
Felix Gardening & Landscaping |
EOR Adjustment Reason |
G4 - This charge was adjusted to comply with the rate and rules of the contract indicated. |
Second Review Reason to dispute incorrect reimbursement |
Claims administrator incorrectly reduced reimbursement. Medical Legal services are not subject to PPO / Network Reductions. Per CCR §9795, ML201 reimbursement is $2,015. With Modifier 93, the value for the procedure is modified by multiplying the normal value by 1.1, totaling $2,216.50. ML201-95-93 payment due: $221.65. In addition to payment, penalties and interest are now due. |
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