California Workers' Comp

Time and Billable Units 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...

CA Providers: Do Not Alter Bill When Submitting Second Review Appeal

To appeal incorrect reimbursements or bill denials, California providers must submit timely and compliant requests for second review. To date, DaisyBill clients have recovere...

CA Drug Formulary Update Effective October 1

California’s Division of Workers’ Compensation (DWC) issued an update to Medical Treatment Utilization Schedule (MTUS) drug formulary, effective October 1, 2018. The formular...

CA Pharmaceutical Fee File Corrected

Providers, take note: California’s Division of Workers’ Compensation (DWC) announced that the Medi-Cal pharmaceutical fee data file, updated weekly, was replaced for the week...

CA: Location-Based Adjustments Set to Take Effect in 2019

In April, the California Division of Workers’ Compensation (DWC) held a hearing regarding the inclusion of the Medicare Geographic Practice Cost Indices (GPCI) in the Physici...

CA Claims Admins Fail to Comply With 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...

CA Pathology/Clinical Laboratory Billing: NCCI Edits Do Not Apply

Medicare’s National Correct Coding Initiative (NCCI) complicates California workers’ comp billing, to say the least. NCCI edits are the source of much confusion, as pr...

Broadspire Denies Unprocessed Workers’ Comp Bills

Broadspire, a global third-party claims administrator (TPA), incorrectly denied several bills for the treatment of an injured worker. While incorrect denials are nothing new ...

CA Workers' Comp: Navigating Billing for Allianz/FFIC

Effective May 1 of this year, insurers Allianz and Fireman’s Fund Insurance Company (FFIC) merged their payment systems for California workers’ comp to reflect Allianz’s 2015...

Maximus Creates IBR Delays With Impossible Demands

Maximus Federal Services, the private entity which conducts Independent Bill Review (IBR) on behalf of California’s Division of Workers’ Compensation (DWC), has always demons...

Clearinghouses Under the Microscope: StoneRiver P2P

Most claims administrators lack the technology to process electronic bills from providers. Instead, these claims administrators rely on clearinghouses. Since DaisyBill has di...

CA Providers: Do Not Provide Additional Reports Without Payment

For California workers’ comp providers, reporting is an important (if sometimes burdensome) requirement. Documentation is everything, hence the requirements for reports like ...