ML201 - Sedgwick Claims Management Services: Grade F

ML201 - Sedgwick Claims Management Services: Grade F

Claims administrator failed to properly reimburse ML201. Sedgwick incorrectly denied valid medical-legal code as “not considered a valid reimbursable code.” Date of Service: 04/09/2021

MLFS Code(s)

ML201 - Comprehensive Medical-Legal Evaluation

MLFS Modifier(s)

95 - Evaluation performed by a panel selected Qualified Medical Evaluator

96 - Evaluation performed by a Psychiatrist or Psychologist when a psychiatric or psychological evaluation is the primary focus of the medical-legal evaluation

MLFS Grade

F

Claims Administrator

Sedgwick Claims Management Services

Bill Review Vendor

Sedgwick CMS National Bill Review

Employer

KinderCare Education

EOR Adjustment Reason

561 - According to the state fee schedule, this procedure code is not considered a valid reimbursable code. Please re-submit with a valid code.

Second Review Reason to dispute incorrect reimbursement

Claims administrator incorrectly 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. ML201-95-96 payment due: $4,030.00. In addition to payment, penalties and interest are now due.


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