ML200 - Pacific Compensation Insurance Company: Grade F

ML200 - Pacific Compensation Insurance Company: Grade F

Claims administrator failed to properly reimburse ML200. Pacific Compensation Insurance Company incorrectly denied valid medical-legal code as not reimbursable. Date of Service: 04/01/2021

MLFS Code(s)

ML200 - Missed Appointment for a Comprehensive or Follow-Up Medical-Legal Evaluation

MLFS Grade

F

Claims Administrator

Pacific Compensation Insurance Company

Bill Review Vendor

CareSolutions / Conduent

Employer

Janitorial Equipment Services Inc

EOR

Adjustment Reason

G6 - According to the official medical fee schedule this service has a relative value of zero and therefore no payment is due.

Second Review Reason to dispute incorrect reimbursement

Claims administrator incorrectly denied reimbursement. Per CCR §9795, ML200 has a Relative Value of 31 and missed appointments are reimbursable when the injured worker fails to appear for the evaluation appointment. ML200 payment due: $503.75. In addition to payment, penalties and interest are now due.   


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