CA Interpreters: No Second Review = No Payment
Dec 2, 2019
Providers — interpreters in particular — be advised: a California appeals court ruled that claims administrator Meadowbrook Insurance is not required to pay a disputed fee fo...
Hanover –> What the H*llover is Going On?
Nov 21, 2019
We have yet another tale of a payer flagrantly ignoring its duty to compliantly process provider bills for treatment of injured workers. This account of payer friction highli...
SB 537: California RFA and Utilization Review Data
Oct 15, 2019
Last week Gavin Newsom, who serves as Governor of California, signed SB 537 into law, thereby adding a new section 138.8 to the Labor Code. This new §138.8 requires the Depar...
The Zenith Unsucessfully Attempts to Undermine IBR Request
Oct 14, 2019
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...
CA OMFS: DMEPOS Fee Schedule Update Effective 10/1/2019
Oct 10, 2019
In Newsline No.: 2019-75, the California Division of Workers’ Compensation (DWC) announced updates to the Official Medical Fee Schedule for Durable Medical Equipment, Prosthe...
CA OMFS: Pathology/Clinical Lab Fee Schedule Update Effective 10/1/2019
Oct 8, 2019
On October 4, 2019, California’s Division of Workers’ Compensation (DWC) ordered an update to the Pathology and Clinical Laboratory section of the Official Medical Fee Schedu...
Huntington Hospital & City of Beverly Hills Change TPAs
Sep 20, 2019
Attention providers: two California employers switched third-party administrators (TPAs).Huntington Hospital transferred claims from Sedgwick to AthensCity of B...
York (aka Sedgwick) Fails Math: EORs Literally Don't Add Up
Sep 19, 2019
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...
Fresno USD Fails to Comply with Electronic Billing Regulations
Sep 17, 2019
For providers treating injured workers, electronic billing is by far the best billing option. For claims administrators in California, it’s not optional at all; accepting ele...
IBR Stats Show Why Fighting Incorrect Reimbursement Is Worth It
Sep 6, 2019
In California, it can be entirely too difficult for providers to collect proper reimbursement for treating injured workers. Among the many reasons for this unfortunate realit...
Claims Admins EXPLOIT Lack of Regulations in Timely Filing Law
Sep 5, 2019
In 2016, California State Bill 1160 was signed into law, instituting new timely filing requirements for workers’ comp medical treatment bills. Since 2017, Labor Code Section ...
Technical Difficulties Trouble San Diego Bill Review Switch
Aug 26, 2019
The City of San Diego, a self-insured, self-administered California employer, is in the process of switching bill review services from Genex to Medata. The transition, though...