Most Recent Articles
Oct 5, 2023
SCIF Inept UR #8: EK Health Makes False MTUS Claim
State Compensation Insurance Fund (SCIF) and EK Healthjust can’t seem to get the hang of Utilization Review (UR).We previousl...
Nov 9, 2023
Gallagher Bassett Flips UR Decision, Confusion Reigns
To an injured worker denied the care their treating physician deems necessary, California’s Utilization Review (UR) process can seem arbitrary, even cruel. This percep...
Nov 14, 2023
Provider Alert: MTI Discount "Contract"
A daisyBill client received a disturbing authorization document to treat an injured City and County of San Francisco (CCSF) employee. MTI America, a self-described “in...
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Dec 4, 2023
Attn CA DWC: Where Is the UR Reporting System?
In 2014, California legislators enacted laws requiring employers to conduct Utilization Review (UR) for every treatment recommended for a work-related injury. I...
Dec 5, 2023
CA DWC: Continued Failure of Regulatory Oversight
California has laws and regulations requiring claims administrators to timely and compliantly conduct Utilization Review (UR) of every treatment recommended by an injured wor...
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Dec 12, 2023
CA: Will DWC Publish Physician UR Denial Data in 2024?
January 1, 2024 is approaching. Will the California Division of Workers’ Compensation (DWC) comply with state law requiring the DWC to publish physician utilization (U...
Dec 15, 2023
UR Data Supports CA Legislators' Fears
As early as 2016, California legislators were aware of potential abuse of the Utilization Review (UR) process. These legislators attempted to address the problem by en...
Jan 9, 2024
Albertsons Employee's Post-Amputation UR Nightmare
Two days before Christmas in 2022, an Albertsons Companies employee suffered “traumatic amputations” of three toes in a work accident. This worker lived alone on the t...
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Feb 1, 2024
DWC Removes Critical Info From FAQ Page
For all the ways California providers can be denied reimbursement for treating injured workers, the state offers one solid protection: a simple (if poorly enfor...
Feb 8, 2024
CA Authorization & UR Confusion Reigns
Last week, we reported on the California Division of Workers’ Compensation (DWC)’s decision to delete an important FAQ from its website. Until the deletion, the FAQ affirmed ...
Feb 9, 2024
Will CA Clean Up Authorization/UR Issues?
When it comes to payer abuse of the authorization process in healthcare, the jig isn’t exactly up yet — but federal legislators and regulators seem to be catching on to priva...
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Mar 22, 2024
AmTrust/Genex Use ODG to Deny Pre-Op Clearance
California law instructs physicians and claims administrators to consult the Medical Treatment Utilization Schedule (MTUS), adopted from the American College of Occupational ...