Authorization
Apr 2, 2024
CA UR: AmTrust & Genex Deny Care With ODG (Again)
What suffering must befall injured workers before California bothers to enforce its meager Utilization Review (UR) requirements?When considering which treatments are n...
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...
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 ...
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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...
Jan 22, 2024
CorVel Adjuster & Attorney Ignore CA Law (Part 1)
Getting paid for treating injured workers can be highly challenging for providers. And sometimes, claims administrators and their representatives can be just plain mean. ...
Jan 22, 2024
CorVel Adjuster & Attorney Ignore CA Law (Part 2)
In the prior installment of this troubling story, a Corvel Senior WC Specialist became belligerent in response to a provider’s inquiry about payment for six bil...
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...
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...
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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 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...
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...