California Workers' Comp

City of Pasadena: CompIQ Saves the Day

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

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

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

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

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"

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

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...

OMFS Update: 59 Codes Newly Billable

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 ...

SB 537 Reveals Murky World of Discount Contracts

In 2019, California passed Senate Bill 537. Among the changes to take effect on July 1st is a disclosure mandate requiring discount contracting entities to disclose to the cl...

Zurich - An Example of California's MPN Shell Game

Where opacity and obfuscation reign, injustice thrives. There may be no better example of this than California’s Medical Provider Network (MPN) system. T...

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...

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.