ML201 - Next Level Administrators: Grade F

ML201 - Next Level Administrators: Grade F

Claims administrator failed to properly reimburse ML201. Next Level Administrators incorrectly underpaid valid medical-legal code as “exceeds the official medical fee schedule allowance. Date of Service: 04/01/2021

MLFS Code(s)

ML201 - Comprehensive Medical-Legal Evaluation

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

Next Level Administrators

Bill Review Vendor

Genex

Employer

Service Staffing LLC

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. ML201-93-95 payment due: $201.50 In addition to payment, penalties and interest are now due.


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