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ML200 - Guard Insurance Group: Grade F

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


Claims Administrator

Guard Insurance Group

Bill Review Vendor

Guard Insurance Group


Eden INR Inc.


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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