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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