AIG: Improper (but Logical) Med-Legal Underpayment
Aug 25, 2021
AIG improperly reduced a California Medical-Legal bill by 88%, providing a dramatic example of how California law incentivizes payers to incorrectly reimburse physicians who ...
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 ...
Med-Legal Diagnostic Testing Is Reimbursable
Aug 19, 2021
FAQ: Is diagnostic testing, as part of a Medical-Legal evaluation, separately reimbursable?A: Yes, as long as the testing is necessary to complete the evaluation.
WorkCompEDI Acquired by Data Dimensions
Aug 16, 2021
WorkCompEDI (WCEDI) has a new owner. The clearinghouse, which processes millions of provider electronic bills annually, was acquired by Data Dimensions, an automation ...
Sedgwick: Sketchy EOR Math for LA Unified School District
Aug 11, 2021
Sedgwick recently returned an Explanation of Review (EOR) that failed to fulfill a crucial requirement: showing how Sedgwick actually calculated the reimbursement amount paid...
City of Pasadena: CompIQ Saves the Day
Aug 10, 2021
Following a switch to a new third-party claims administrator (TPA), the City of Pasadena violated California law by suddenly failing to accept electronic bills for the treatm...
2021 Telehealth Billing Guide for CA Workers' Comp
Aug 9, 2021
With COVID-19 hardly in the rearview mirror just yet, California workers’ comp providers can still utilize telehealth as a safer alternative to in-person treatment. But of co...
Disneyland Churns Out Incorrect e-Bill Rejections
Aug 5, 2021
Providers billing Disneyland Resorts, be warned: your electronic bills might be erroneously rejected.Recently, we reported on Disneyland Resorts’ switching its bill re...
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...
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...
IBR Hall of Shame: Sedgwick Sets New Standard of Noncompliance
Jul 6, 2021
Sedgwick failed to comply with an Independent Bill Review (IBR) ruling for almost four months. Worse, the payor’s brazenness is likely to go unpenalized by the state.T...