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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