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ML202 - AIG Claims, Inc.: Grade F

ML202 - AIG Claims, Inc.: Grade F

Claims administrator failed to properly reimburse ML202. AIG incorrectly denied valid medical-legal code as “not considered a valid reimbursable code.” Date of Service: 04/06/2021

MLFS Code(s)

ML202 - Follow-up Medical-Legal Evaluation

MLFS Modifier(s)

93 - Interpreter needed at time of examination

MLFS Grade

F

Claims Administrator

AIG Claims, Inc.

Bill Review Vendor

AIG Claims, Inc.

Employer

SGL Carbon, LLC

EOR Adjustment Reason

2 - This charge will be re-evaluated upon receipt of the proper procedure codes or procedure code/modifier combination as listed in the fee schedule.

Second Review Reason to dispute incorrect reimbursement

Claims administrator incorrectly denied reimbursement. Per CCR §9795, ML202 is valid reimbursable procedure code for a Follow-up Medical-Legal Evaluation by a physician which occurs within eighteen months of the date on which a prior Comprehensive Medical-Legal evaluation was performed by the same physician. Provider conducted a Follow-up Medical-Legal Evaluation at the request of the parties. ML202-93 payment due: $1,447.88. In addition to payment, penalties and interest are now due.


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