California Workers' Comp
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May 20, 2021
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...
May 19, 2021
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.
May 12, 2021
CNA Repeatedly Ignores California Law
By law, claims administrators must remit payment for Medical-Legal services within 60 days of receiving the physician’s bill. As of this writing, payment to one physician fro...
Apr 21, 2021
Mob Rule: SCIF/Anthem Hold Patient(s) Hostage
On paper, Medical Provider Networks (MPNs) are a simple workers’ comp quality/cost-control measure. Employers designate an MPN, and injured workers choose from among the MPN ...
Apr 8, 2021
2021 CA Med-Legal Billing Codes Pocket Guide
California has a new Medical-Legal Fee Schedule (MLFS), effective April 1. To help medical-legal evaluators and their staff navigate these (drastic) changes, we created a dow...
Apr 7, 2021
Broadspire Pays Provider 47% Below CA OMFS
It happens every year: Reimbursement rates for workers’ compensation services in California change, and payers reimburse providers at the lesser, previous rates.It hap...
Apr 5, 2021
City & County of San Francisco's Misleading Reply in PPO Dispute
Recently, a DaisyBill provider disputed a reduction in reimbursement from the City and County of San Francisco (CCSF) for treating an injured employee. In the Explanation of ...
Apr 2, 2021
Broadspire Knows No Law But Its Own
Broadspire continues to break the rules, seemingly confident that California regulators will not hold the claims administrator to account. For months, we reported on B...
Apr 1, 2021
Medical-Legal Cheat Sheet for CA Workers' Comp
It’s official: California workers’ compensation has a new Medical-Legal Fee Schedule (MLFS). The updated MLFS is effective for dates of service on or after April 1, 20...
Mar 31, 2021
New CA Med-Legal Fee Schedule Effective April 1
California’s Office of Administrative Law (OAL) issued final approval of the revamped Medical-Legal Fee Schedule (MLFS) for workers’ compensation, effective for dates of serv...
Mar 30, 2021
CA: New Med-Legal Fee Schedule Pending
A reimagined Medical-Legal Fee Schedule is on the way.Following the required public hearing and comment period, California’s Division of Workers’ Compensation (DWC) fi...
Mar 30, 2021
Zurich Denies Liability After Accepting Liability
Zurich recently denied liability for an injured workers’ treatment, claiming the 2003 injury was not work-related — despite the fact that Zurich already authorized the treatm...