California Workers' Comp
Feb 8, 2019
The Payment Chaos Continues: Sedgwick Denies Appeal for Correct 2019 Reimbursements
Sedgwick’s payment mistakes multiply. First, Sedgwick incorrectly paid California providers by applying an old workers’ comp fee schedule. Now Sedgwick compounds its error by...
Feb 6, 2019
2019 Splinting & Casting Reimbursement Update
When navigating the seas of change, it’s refreshing to find an island of relative stability. Like California’s state-specific codes, the splinting and casting codes group (co...
Feb 5, 2019
State Farm Workers’ Comp Claims Moved to Sedgwick CMS
Time to start counting your poultry -- State Farm’s workers’ compensation henhouse is now guarded by the third-party administrator (TPA) Sedgwick, effective October 21, 2018....
Feb 4, 2019
California-Specific Codes Updated for 2019
With the flurry of new year fee schedule changes, California updated the Physician Fee Schedule reimbursement for its state-specific codes. These codes are explained in 8 CCR...
Feb 1, 2019
Sedgwick Still Reimbursing at 2018 Rates for California
Since the beginning of 2019, Sedgwick CMS has incorrectly used the 2018 Physician Fee Schedule to reimburse providers. Our data indicates that Sedgwick is consistently and in...
Feb 1, 2019
2019 CA Workers’ Comp Evaluation & Management Cheat Sheet
The 2019 changes to California’s reimbursements got your head spinning? Here’s a handy reimbursement cheat sheet for the most frequently used Evaluation & Management codes.
Nov 29, 2018
CA OMFS Inpatient Hospital Fee Schedule Update
California’s Division of Workers’ Compensation (DWC) posted an adjustment to the Inpatient Hospital section of the Official Medical Fee Schedule (OMFS), effective for dischar...
Nov 18, 2018
The 5 Point Checklist for CPT Codes 99358 and 99359
Changes have been made to the California OMFS since the publication of this article. Be sure to see the latest analyses here and here.2021 OMFS updates drastically cha...
Nov 8, 2018
CA Claims Admin Delays Payment, Skirts IBR Rules
When the Independent Bill Review (IBR) process overturns a claims administrator’s incorrect denial or adjustment, the claims administrator is legally bound to timely pay what...
Oct 12, 2018
CA: Employers 100% Responsible for UR Mistakes
In a much-anticipated ruling, California’s Supreme Court ruled that a secondary injury derived from an incorrect Utilization Review (UR) decision is compensable under workers...
Oct 10, 2018
Bill "Auditing" Services Try to Bamboozle Providers
Recently, MARS (Medical Audit and Review) made a very strange — and very dubious — offer to a California provider on behalf of the claims administrator, Farmers Insurance.
Oct 10, 2018
No Response to Second Review Request? A Lien Is the Only Option
A recent refusal by Travelers Insurance to respond to a provider’s second review appeal, and subsequent denial of the provider’s request for Independent Bill Review (IBR), pe...