Most Recent Articles
Jun 6, 2019
Pro Tip: Submit RFAs During Liability Disputes
When the employer and injured worker are locked in an injury liability dispute, the provider is frequently caught in the crossfire. Often, treatment cannot wait for the long ...
Jun 13, 2019
CA Payors Put the Squeeze on Providers (Again)
In California, box 1a of the CMS 1500 billing form is for the injured worker’s Social Security Number (SSN). When the claims administrator insists the provider populate box 1...
Jul 8, 2019
Magna Carta - Bills Not Processed
Providers, be aware that Magna Carta Companies (formerly PSM) ended its relationship with its bill review service, CorVel. More importantly, Magna Carta is not responding to ...
Jul 17, 2019
Mitchell Unresolved EOR Mess
A persistent glitch in Mitchell’s bill review service is causing revenue management chaos for providers. For second review appeals, providers receive electronic explanations ...
Sep 19, 2019
York (aka Sedgwick) Fails Math: EORs Literally Don't Add Up
York Risk Services, which was acquired this month by Sedgwick, has significant math troubles. York recently returned Explanations of Review (EORs) which obfuscated the effect...
Oct 14, 2019
The Zenith Unsucessfully Attempts to Undermine IBR Request
Claims administrators continue to innovate new techniques that make it harder for providers to receive proper reimbursement. In this installment, we tell a tale of the length...
Oct 17, 2019
York EORs Create Revenue Management Headaches
York Insurance has repeatedly reported incorrect payment amounts in recent Final Explanations of Review (EORs), which are issued in response to second review appeals. These F...
Dec 5, 2019
STRONG WARNING! Travelers Refuses to Pay Provider
We advise providers to think carefully before treating injured workers covered by Travelers. Below, we summarize the nightmarish run-around that an MPN provider experienced w...
Feb 5, 2020
CPTs 99358 & 99359 - 2020 CA Reimbursement Cheat Sheet
Changes have been made to the California OMFS since the publication of this article. Be sure to see the latest analyses here and here.2021 OMFS updates drastically cha...
Feb 6, 2020
California-Specific Codes - 2020 Reimbursement Updates
Attention California providers -- in 2020 reimbursements increased for all California-specific workers’ comp codes!In the Physician Fee Schedule, these state-specific ...
Mar 4, 2020
CorVel Disguises PPO Discounts
We’ve raised the alarm about Preferred Provider Organization (PPO) and Network discount contracts before. Supposedly, in exchange for more patients, these PPO and Network con...
Feb 22, 2021
Sedgwick & Mitchell Setting Up a Legal Protection Racket?
Sedgwick, in cahoots with Mitchell, seems to be setting up some kind of protection racket where, in exchange for providers accepting lower reimbursement, Sedgwick/Mitchell wi...