ML200 - Guard Insurance Group: Grade F
Claims administrator failed to properly reimburse ML200. Guard incorrectly reduced reimbursement by taking a noncompliant PPO reduction.
Date of Service: 04/05/2021
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 |
Guard Insurance Group |
Bill Review Vendor |
Guard Insurance Group |
Employer |
Eden INR Inc. |
|
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. ML200-95 payment due: $35.26. In addition to payment, penalties and interest are now due. |
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