California Workers' Comp

PPO Data Update: The Toll on CA Doctors Who Treat Injured Workers

DaisyBill’s California OMFS Reimbursement Reduction page tracks in minute detail the data around Preferred Provider Organization (PPO) and other discount contracts. Now, we’v...

TPA Changes: City of Alameda, Torrance Unified Schools

Two California public employers switched third-party administrators (TPA) recently, affecting bills for all dates of service. The City of Alameda and the Torrance Unified Sch...

Pasadena Is (Still) Violating CA Workers' Comp Law

As costs skyrocket, physicians flee the system, and injured workers find it harder and harder to find a doctor willing to treat them, California workers’ comp has yet to reck...

Dollar Tree/Sedgwick Won’t Pay for Authorized Treatment

Authorization is, by definition, a promise.It’s the promise that, once a doctor obtains authorization from an employer to treat an injured worker, the employer will pa...

Med-Legal Reports: Always Include Page Count Verification!

California’s new Medical-Legal Fee Schedule (MLFS), effective from April 2021, brought with it new rules for reporting, billing, and payment. Among those rules: when submitti...

SCIF Hacks IBR by Switching (Incorrect) Denial Reason

There’s a serious inequity in the appeals process by which California workers’ comp providers can dispute incorrect reimbursement for authorized treatment. State Compensation...

A Doctor's Warning: PPOs "Helped Close Our Doors"

Recently we received an email from a retired California doctor. This doctor, after 35 years treating injured workers, was unable to sell his practice — because no other provi...

AIG: Improper (but Logical) Med-Legal Underpayment

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

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

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

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

Sedgwick recently returned an Explanation of Review (EOR) that failed to fulfill a crucial requirement: showing how Sedgwick actually calculated the reimbursement amount paid...