California Workers' Comp

Warning: ECHO Deducts "Service Fee" From Paradigm Payment

As daisyNews explored in recent articles, Paradigm Specialty Networks profits by intercepting providers' reimbursements for injured workers' treatment, imposing reductions, a...

Zurich, Paradigm Hit CA Provider With $786 Reduction (and $195 IBR Fee)

Paradigm Specialty Networks functions as a twisted sort of toll collector, inserting itself into the reimbursement flow between workers' comp payers and ...

CA: JPMorgan’s InstaMed Leaves Gallagher Bassett Out of Compliance

Third-Party Administrator (TPA) Gallagher Bassett has failed to send electronic Explanations of Review (e-EORs) in response to thousands of providers’ electronic bills (e-bil...

CA: How Paradigm Intercepts Employers’ Comp Dollars

Private equity is profiting from funds intended for the care of injured workers. California employers, regulators, and providers deserve a clear accounting of where workers’ ...

CA DWC’s List of “Active” MPNs Lists a Single MPN

Last week, daisyNews documented how Employers Compensation Insurance Company denied bills by questionably citing MPN non-membership,...

CA Providers: Good Luck Fighting MPN Payment Denials

Yesterday, daisyNews shared data on payment denials citing non-membership in Medical Provider Networks (MPNs) and, in multiple cases, showed that ...

CA: Suspicious MPN Payment Denials Are Rampant

In California, Medical Provider Networks (MPNs) theoretically allow employers and their comp insurers to ensure that injured workers receive appropriate care at reasonable co...

CA Billing Alert: Alisal Union Schools’ TPA Pays Below Medicare Rates

California’s fee schedule for workers’ comp treatment pays physicians more than Medicare rates (currently 55% more) to account for the extraordinary time, work, and administr...

Liberty Mutual Plays “IBR (and IMR) Chicken” on UPS Claim

Two unfortunate necessities exemplify the broken state of California’s dysfunctional workers’ comp system:Too often, payers deny an injured worker's care, and the work...

CA DWC: Providers Must Use RFA Form (While Payers Can Do What They Please)

In California, before treating an injured worker, a physician must obtain prior approval from the payer for all treatment. The California Division of Workers’ Compensation (C...

CA EOR Trap #1: ECHO Withholds EORs as Bait for MPX Sales Pitch

Payment processing vendor ECHO Health is withholding Explanations of Review from California workers' compensation providers. ECHO then uses the missing EORs as bait to compel...

Data: PPOs Are Another “Cost Control” Measure That Hurts CA Employers

California employers pay more than almost any other state for comp coverage, with premiums set to rise again in September. California claims take twice as long and cost twice...