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ML203 / MLPRR - Helmsman Management Services: Grade F

ML203 / MLPRR - Helmsman Management Services: Grade F

Claims administrator failed to properly reimburse ML203 and MLPRR. Helmsman Management Services incorrectly denied valid medical-legal code as not reimbursable. Date of Service: 04/01/2021

MLFS Code(s)

ML203 - Fees for Supplemental Medical-Legal Evaluations

MLPRR - Record Review

MLFS Grade

F

Claims Administrator

Helmsman Management Services

Bill Review Vendor

Helmsman Management Services

Employer

ADP TotalSource

Bill Processing Day Count

8 days to process bill from submission

EOR Adjustment Reason

531 - Please re-submit with the appropriate HCPCS/CPT Code.

Second Review Reason to dispute incorrect reimbursement: ML203

Claims administrator incorrectly denied reimbursement. Per CCR §9795, ML203 is valid reimbursable procedure code that includes services for writing a report after receiving a request for a supplemental report from a party to the action or receiving records that were not available at the time of the initial or follow-up comprehensive medical-legal evaluation. Provider conducted a Supplemental Medical-Legal Evaluation at the request of the parties. ML203 payment due: $650.00. In addition to payment, penalties and interest are now due.

Second Review Reason to dispute incorrect reimbursement: MLPRR

Claims administrator incorrectly denied reimbursement. Per CCR §9795, MLPRR is a valid reimbursable procedure code used to identify charges for review of records in excess of pages included in medical-legal numerical billing codes. Excess pages are billed at three dollars per page. Provider documented record review page count in report. MLPRR payment due: $75.00. In addition to payment, penalties and interest are now due.


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