California DWC
Jun 29, 2021
Med-Legal Bill Denied for Liability? Request IBR
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...
Jun 28, 2021
CA DWC Lets SCIF Skirt IBR for Incorrect GPCI
In a baffling decision, the California Division of Workers’ Compensation (DWC) declared a straightforward billing dispute ineligible for Independent Bill Review (IBR) — despi...
Jun 4, 2021
Sedgwick Defies DWC COVID Rules; DWC Washes Hands
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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May 20, 2021
MPNs: The Jekyll and Hyde of Workers' Comp
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...
May 19, 2021
Anthem: PPO Discount Payments BELOW Medicare
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.
May 12, 2021
CNA Repeatedly Ignores California Law
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...
Apr 5, 2021
City and County of San Francisco's Misleading Response in PPO Discount Dispute
Recently, a DaisyBill provider disputed a reduction in reimbursement from the City and County of San Francisco (CCSF) for treating an injured employee. In the Explanation of ...
Apr 2, 2021
Broadspire Knows No Law But Its Own
Broadspire continues to break the rules, seemingly confident that California regulators will not hold the claims administrator to account. For months, we reported on B...
Mar 31, 2021
New CA Med-Legal Fee Schedule Effective April 1
California’s Office of Administrative Law (OAL) issued final approval of the revamped Medical-Legal Fee Schedule (MLFS) for workers’ compensation, effective for dates of serv...
Mar 29, 2021
CA OMFS: Physician Fee Schedule Update Effective April 1
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 ...
Mar 26, 2021
Zurich Delays Telehealth Reimbursement During Pandemic
Zurich seems committed to a policy of improperly denying reimbursement for telehealth services, during a pandemic in which remote treatment is crucial to maintaining care for...
Mar 15, 2021
How to Apply HCPCS G2212 in CA Workers' Comp
Important Update: The DWC adopted an MUE limiting the number of units of G2212 providers may bill. Details below!This year, California’s Division of Workers’ Compensat...