California Workers' Comp
Aug 16, 2021
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 ...
Aug 11, 2021
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...
Aug 10, 2021
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...
Aug 9, 2021
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...
Aug 5, 2021
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...
Aug 4, 2021
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...
Jul 13, 2021
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...
Jul 12, 2021
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...
Jul 6, 2021
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...
Jul 5, 2021
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 ...
Jun 30, 2021
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...
Jun 21, 2021
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...