Most Recent Articles
Apr 1, 2021
ML202 - SCIF (CA): Grade A
Claims administrator properly processed reimbursement for ML202. Date of Service: 04/09/2021
Apr 1, 2021
ML203 - State Compensation Insurance Fund (CA): Grade A
Claims administrator properly processed reimbursement for ML203. Date of Service: 04/12/2021
Apr 1, 2021
ML200 - State Compensation Insurance Fund (CA): Grade A
Claims administrator properly processed reimbursement for ML200. Date of Service: 04/27/2021
Apr 1, 2021
ML201 - Next Level Administrators: Grade F
Claims administrator failed to properly reimburse ML201. Next Level Administrators incorrectly underpaid valid medical-legal code as “exceeds the official medical fee schedul...
Aug 17, 2021
Med-Legal: PPO Discounts Do NOT Apply to MLFS
Preferred Provider Organization (PPO) and other network discounts do not apply to the Medical-Legal Fee Schedule (MLFS). Period.In other words, the MLFS and OMFS are c...
Apr 1, 2021
ML201 - Liberty Mutual Insurance: Grade F
Claims administrator failed to properly reimburse ML201. Liberty Mutual incorrectly underpaid valid medical-legal code as “exceeds the official medical fee schedule allowance...
Apr 1, 2021
ML201 - Guard Insurance Group: Grade F
Claims administrator failed to properly reimburse ML201. Guard incorrectly incorrectly reduced reimbursement by taking a noncompliant PPO reduction. Date of Service: 04/17/20...
Apr 1, 2021
ML201 - CorVel: Grade A
Claims administrator properly processed reimbursement for ML201. Date of Service: 04/03/2021
Aug 19, 2021
Med-Legal Diagnostic Testing Is Reimbursable
FAQ: Is diagnostic testing, as part of a Medical-Legal evaluation, separately reimbursable?A: Yes, as long as the testing is necessary to complete the evaluation.<...
Apr 1, 2021
ML200 - Enstar Group: Grade A
Claims administrator properly processed reimbursement for ML200. Date of Service: 04/23/2021
Apr 1, 2021
ML203 / ML205 - Sentry Insurance: Grade A
Claims administrator properly processed reimbursement for ML203. Date of Service: 04/25/2021
Aug 25, 2021
AIG: Improper (but Logical) Med-Legal Underpayment
AIG improperly reduced a California Medical-Legal bill by 88%, providing a dramatic example of how California law incentivizes payers to incorrectly reimburse physicians who ...