ML200 - Sedgwick Claims Management Services: Grade F

ML200 - Sedgwick Claims Management Services: Grade F

Claims administrator failed to properly reimburse ML200. Sedgwick incorrectly denied valid medical-legal code as “not considered a valid reimbursable code.” Date of Service: 04/02/2021

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

Sedgwick Claims Management Services

Bill Review Vendor

Sedgwick CMS National Bill Review

Employer

Whittier Area S.I.A.

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, ML200 is a valid code with a Relative Value of 31. Missed appointments are reimbursable when the injured worker fails to appear for the evaluation appointment. ML200-95 payment due: $503.75. In addition to payment, penalties and interest are now due.


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