ML203 / MLPRR - Beta Healthcare Group Risk Management Authority: Grade F

ML203 / MLPRR - Beta Healthcare Group Risk Management Authority: Grade F

Claims administrator failed to properly reimburse MLPRR. Beta Healthcare Group incorrectly reduced reimbursement for record review citing “charge exceeds the official medical fee schedule allowance.” Date of Service: 04/01/2021

MLFS Code(s)

ML203 - Fees for Supplemental Medical-Legal Evaluations

MLPRR - Record Review

MLFS Grade

F

Claims Administrator

Beta Healthcare Group Risk Management Authority

Bill Review Vendor

Beta Healthcare Group

Employer

Easter Seals Southern California, Inc

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: MLPRR 

Claims administrator incorrectly reduced 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: $5,592.00. In addition to payment, penalties and interest are now due.


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