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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