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ML201 / MLPRR - Broadspire: Grade F

ML201 / MLPRR - Broadspire: Grade F

Claims administrator failed to properly reimburse ML201 and MLPRR. Broadspire incorrectly reduced reimbursement by taking a noncompliant PPO reduction. Date of Service: 04/13/2021

MLFS Code(s)

ML201 - Comprehensive Medical-Legal Evaluation

MLPRR - Record Review

MLFS Modifier(s)

93 - Interpreter needed at time of examination

95 - Evaluation performed by a panel selected Qualified Medical Evaluator

MLFS Grade

F

Claims Administrator

Broadspire

Bill Review Vendor

Broadspire

Employer

99 Cents Only Stores

EOR

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: ML201

Claims administrator incorrectly reduced reimbursement. Medical Legal services are not subject to Preferred Provider Organization (PPO) or Network Reductions. ML201-95-93 payment due: $110.82. In addition to payment, penalties and interest are now due.

Second Review Reason to dispute incorrect reimbursement: MLPRR

Claims administrator incorrectly denied reimbursement. Per CCR §9795, MLPRR is a valid reimbursable procedure code used to identify charges for review of records in excess of pages included in medical-legal numerical billing codes. Excess pages are billed at three dollars per page. Provider documented record review page count in report. MLPRR payment due: $2,490.00. In addition to payment, penalties and interest are now due.


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