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ML201 - Guard Insurance Group: Grade F

ML201 - Guard Insurance Group: Grade F

Claims administrator failed to properly reimburse ML201. Guard Insurance Group incorrectly denied valid medical-legal code as exceeding fee schedule allowance. Date of Service: 04/01/2021

MLFS Code(s)

ML201 - Comprehensive Medical-Legal Evaluation

MLFS Modifier(s)

95 - Evaluation performed by a panel selected Qualified Medical Evaluator
93 - Interpreter needed at time of examination

MLFS Grade

F

Claims Administrator

Guard Insurance Group

Bill Review Vendor

Guard Insurance Group

Employer

T O Transport Corporation

Bill Processing Day Count

11 days to process bill from submission

EOR Adjustment Reason

G1 - The charge exceeds the official medical fee schedule allowance. The charge has been adjusted to the scheduled allowance.

Second Review Reason to dispute incorrect reimbursement

Claims administrator incorrectly reduced reimbursement. Per CCR §9795, ML201 reimbursement is $2,015. With Modifier 93, the value for the procedure is modified by multiplying the normal value by 1.1, totaling $2,216.50. ML201-95-93 payment due: $201.50 In addition to payment, penalties and interest are now due.


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