Most Recent Articles

ESIS Refuses to Answer Phone or Pay Med-Legal Doctor

ESIS, a third-party administrator (TPA) for Ace American Insurance, is failing miserably in its legal duty to timely reimburse a California physician evaluator for Medical-Le...

CA Med-Legal: How to Appeal Unpaid AME Modifier -94

Regularly, California workers’ comp claims administrators incorrectly deny Medical-Legal Fee Schedule (MLFS) modifier -94 for Agreed Medical Evaluator (AME) services. In this...

CA Med-Legal How-To: Collect Penalty & Interest Payments

California physician evaluators, be advised: when claims administrators are late in paying for Medical-Legal services, penalty and interest payments apply. However, inadequat...

ESIS Continues to Refuse Payment for Med-Legal Evaluations

Third-party claims administrator (TPA) ESIS systematically refuses to pay bills for Medical-Legal services. Full stop. Below, we list 9 Medical-Legal bills — some more...

CA Med-Legal: $76 Million Owed For Record Review in First Year

It’s been just over a year since California adopted the new Medical-Legal Fee Schedule (MLFS). Effective April 1, 2021, the new MLFS represented the first incre...

Med-Legal: Cannon Cochran Denies Payment for Interpreter Services

Medical-Legal physician evaluators, be advised: a disturbing payment denial tactic is catching on among California claims administrators. When responding to physician ...

Free: CA Med-Legal "Superbills"

Medical-Legal billing for California workers’ comp is fraught with complications, contradictions, and — of course — threats to physician revenue from less-than-scrupulous ent...

PPO Discounts STILL NOT Applicable to Med-Legal

It’s hard to believe we still have to write this — or is it? California claims administrators may not apply Preferred Provider Organization (PPO) reductions to physici...

DWC Seeks QMEs for October Exam

California’s Division of Workers’ Compensation (DWC) is accepting applications from physicians for the October 2022 Qualified Medical Evaluator (QME) exam.The in-perso...

CA Med-Legal Fees, QMEs Under Attack

A recent study on the current Medical-Legal Fee Schedule (MLFS) has triggered a wave of pearl-clutching by payer advocates. So what has the payer-side pundits groping for the...

(Free, Transparent) CA Med-Legal Fee Schedule Data

As the California Workers’ Compensation Institute (CWCI) peddles paid access to its insurer-derived data and white-tie webinars, daisyBill would like to offer an update on th...

ESIS: 10 Audit Complaints Filed With CA DWC

California law requires claims administrators to send an Explanation of Review (EOR) and payment to the physician within 60 days of receiving a bill for Medical-Legal service...