California Workers' Comp

2018 Average Days to Payment for Medical Treatment Bills

In 2018, for California medical treatment bills submitted using DaisyBill software, the average processing time is 11 days for the top 20 claims administrators by volume. We’...

SCIF (CA) Incorrectly Paying 2018 Fee Schedule for 2019 DOS

It’s SCIF’s turn. The California State Compensation Insurance Fund (SCIF) is also incorrectly reimbursing providers using the 2018 Physician Fee Schedule instead of the corre...

Reminder: Timely Bills Are Mandatory

Late bills will not be paid. Period. Timely billing has been in effect in California workers’ compensation since January 1, 2017, but we still see providers missing th...

Maximus Confirms Using Second Review Appeals to Correct Billing Errors

Correcting a coding error is as simple as submitting a Second Review appeal explaining the error. Last year, we discussed the convoluted process to correct billing err...

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...

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...

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....

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...

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...

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.

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...

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...