California Workers' Comp
Jan 17, 2023
CA EDI Compliance: 2022 e-Billing Report Card
For over ten years, California has had a simple legal requirement: all claims administrators must accept electronic bills from providers for the treatment of injured workers....
Jan 11, 2023
Sedgwick Authorization Sewer - Why CA Needs UR Reform
An injury occurs at work. The injured worker sees a doctor. The doctor concludes that the worker needs a consultation from a specialist. Per California law, the treating doct...
Jan 5, 2023
Tristar: 16,459 Audit Complaints Filed
For all its complexity, California workers’ comp has one very simple law: if a doctor chooses to send bills electronically, the claims administrator must accept that doctor’s...
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Jan 5, 2023
DMEPOS Update Q1 2023
California’s Division of Workers’ Compensation (DWC) updated the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) portion of the Official Medical Fee ...
Jan 5, 2023
CA Physician Fee Schedule: No 2023 Changes (Yet)
Despite controversial cuts to reimbursement rates for Medicare, California’s Division of Workers’ Compensation (DWC) has not announced changes to reimbursement ...
Jan 5, 2023
Tristar: 8,188 Audit Complaints Filed With CA DWC
Using data generated by over 36,000 electronic bills sent by our provider clients in 2022, daisyBill demonstrates consistent non-compliance with California e-billing regulati...
Dec 14, 2022
Sedgwick's 57,876 Audit Complaints: A Business Practice?
Sedgwick received our open letter, but the Third-Party Administrator (TPA) still missed the memo. Sedgwick administers claims on behalf of insurers and self-insured em...
Dec 14, 2022
WCF Falsely Demands QME Refund
A friendly reminder to all California Qualified Medical Evaluators (QMEs) and Agreed Medical Evaluators (AMEs): when a claims administrator demands a refund of reimbursement ...
Dec 14, 2022
Can CA (or Anyone) Trust CareWorks?
CareWorks, a Managed Care Organization (MCO) that offers services such as bill review, utilization review, and “physician network services,” is in legal hot water with the St...
Dec 14, 2022
Sedgwick Missing e-EORs: 31,906 Audit Complaints Submitted
Sedgwick Claims Management Services is breaking the law. We encourage the California Division of Workers’ Compensation (DWC) to assert its role in upholding workers’ comp law...
Dec 8, 2022
2022 Non-Compliance Report: 6 Admins That Fail to Send e-EORs
California workers’ comp switched to electronic billing for very good reasons. e-Billing is much, much faster, wastes far fewer resources, and goes a very long way tow...
Dec 8, 2022
Med-Legal Data: IBR Is the QME/AME's Friend
California workers’ comp presents serious challenges to physicians — and Medical-Legal physicians are no exception. Despite a recently simplified Medical-Legal Fee Sch...