CA Cheat Sheet: Required Reports & Supporting Documentation for Workers' Comp Bills
Aug 19, 2021
In California, when submitting a bill for treating an injured worker, it’s imperative to include the correct documentation to support the treatment. If the provider fails to ...
Audit Complaint: PacificComp Fails to Process e-Bills
Aug 4, 2021
In California workers’ comp, a provider’s failure to adhere to the billing regulations allows the payer to refuse payment for treatment of the injured worker. But all too oft...
Sedgwick Violates LACoFD Employer Contract, IBR Drops Ball
Jul 15, 2021
A physician agreed to serve as Independent Medical Examiner (IME) for the Labor Management Committee (LMC) representing the Los Angeles County Fire Department (LACoFD) and Lo...
CA Workers' Comp Q&A Highlights
Jul 13, 2021
We asked our readers to submit their most vital California workers’ comp questions for a live Q&A webinar. They did not disappoint!If you missed it, below is a brief r...
Sedgwick Denies Second Review Appeals as "Duplicates"
Jul 12, 2021
Sedgwick has a Second Review problem.On too many occasions, Sedgwick incorrectly denies providers’ Second Review appeals as “duplicate submissions” of the original bil...
OMFS Update: 59 Codes Newly Billable
Jul 5, 2021
California’s Division of Workers’ Compensation (DWC) issued an update to the Physician and Non-Physician Practitioner portion of the Official Medical Fee Schedule (OMFS) for ...
Med-Legal Bill Denied for Liability? Request IBR
Jun 29, 2021
Certain California workers’ comp payers deny reimbursement for Medical-Legal evaluations by claiming lack of liability for the initial injury. With this twisted, circular log...
CA DWC Lets SCIF Skirt IBR for Incorrect GPCI
Jun 28, 2021
In a baffling decision, the California Division of Workers’ Compensation (DWC) declared a straightforward billing dispute ineligible for Independent Bill Review (IBR) — despi...
Sedgwick Defies DWC COVID Rules; DWC Washes Hands
Jun 4, 2021
Sedgwick defied California workers’ comp regulations, costing a provider thousands in due reimbursement. Unfortunately, the Division of Workers’ Compensation (DWC) has declin...
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MPNs: The Jekyll and Hyde of Workers' Comp
May 20, 2021
We’ve argued that MPNs are mostly a drag on the workers’ compensation system. But as some employers demonstrate, they don’t have to be.When employers use MPNs to maint...
Anthem: PPO Discounts Result in Payments BELOW Medicare
May 19, 2021
Q: How much can a workers’ comp provider lose by signing a Preferred Provider Organization (PPO) agreement?A: Much, much more than the provider probably realizes.
CNA Repeatedly Ignores California Law
May 12, 2021
By law, claims administrators must remit payment for Medical-Legal services within 60 days of receiving the physician’s bill. As of this writing, payment to one physician fro...