Workers’ comp providers, be aware: insurer Sedgwick has recently incorrectly rejected multiple bills on erroneous grounds, necessitating that time and resources be spent investigating the claims administrator’s mistake.

In one example, Sedgwick claimed that the employer in question was not a Sedgwick client (although it was). In another, Sedgwick was simply unable to match the bill to a (valid) claim. In both cases, Sedgwick was wrong, as confirmed by Sedgwick’s own representatives. These are not the only examples of what may be a more widespread issue.

If your office receives a letter from Sedgwick rejecting a bill for either of the reasons above, don’t take their word for it. Contact Sedgwick to investigate further.

Discovering Sedgwick’s Errors

A DaisyBill provider-client reached out to us for help when, after submitting a compliant original bill, the provider received a letter from Sedgwick which stated:

Sedgwick administers claims for multiple clients. We have received the enclosed correspondence and are returning it for the following reasons: No longer a Sedgwick CMS client

Assuming Sedgwick was a credible authority on whether or not a given employer was a Sedgwick client, the provider took the letter of rejection at face value. The provider’s staff contacted DaisyBill for guidance on finding out which claims administrator the employer utilized. We advised the provider to reach out to Sedgwick for that information.

But our representative’s “DaisySense” was tingling. As is too often the case in workers’ comp billing, something didn’t add up. Our Compliance Team probed further.

When our Compliance Team contacted Sedgwick, we confirmed that the employer in question was in fact still a Sedwick client. Upon hearing that it was Sedgwick’s error, the provider sent us multiple examples of similarly invalid rejections, including the above-mentioned failure to match bills to any Sedgwick claims.

Stay on Top of Claims Admins

The moral of this story? Providers must accept a simple but infuriating truth in order to protect their office’s revenue: claims administrators like Sedgwick make mistakes because there is no incentive to avoid the kind of errors that shortchange providers.

Therefore, it’s on providers and their agents to keep claims administrators honest...so to speak.

Sometimes, claims administrator-induced friction is the result of knowing malfeasance. Other times, it’s simply because striving for competence doesn’t seem like a necessary investment for claims administrators in an industry that keeps the burden of enforcement on providers.

Either way, err on the side of caution. If a rejection, denial, or adjustment seems too ridiculous to be true...it probably is.

One way to ensure correct, timely reimbursement: reliable workers’ comp-specific billing software. We know the rules, the fee schedules, and what it takes to bill beautifully. Plus, our Compliance Team addresses payer shenanigans with aplomb. Schedule a free demonstration today.

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