California Workers' Comp
May 29, 2024
CA Provider Warning: P&S vs Med-Legal Reports
This is an essential report warning for California providers. A Permanent and Stationary (PR-4) report and a Medical-Legal evaluation report are not interchangeable. Before i...
May 28, 2024
Santa Monica & Lien on Me Improperly Reimburse MDs
In California workers’ comp, claims administrators often suffer from a troubling payment syndrome we call “Fee Schedule Lag.” The symptoms of Fee Schedul...
May 21, 2024
CA: Del Taco Fails to Pay for Injured Employees
Need (yet another) illustration of what happens when a state establishes a consequence-free environment for workers’ comp claims administrators? There is currently no ...
May 13, 2024
Sedgwick Stiffs Doctors With Outdated Fee Schedule Rates
The California Division of Workers’ Compensation (DWC) increased reimbursements for physician services for dates of service on or after April 1, 2024. Yet Third-Party Adminis...
May 7, 2024
CorVel Corrects Reimbursement Errors
California workers’ comp fee schedules aren’t easy to keep up with. Subject to constant revision, the complex formulas for calculating correct reimbursement are more t...
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May 6, 2024
Marriott (Finally) Sending e-EORs
Fans of workers’ comp billing and payment compliance, rejoice! After literally years of hounding from daisyBill, self-insured employer Marriott is finally adhering to ...
May 3, 2024
Sedgwick Fails to Pay IBR Filing Fee for Zillionth Time
Once more for the cheap seats: when Independent Bill Review (IBR) determines that a claims administrator erroneously denied or adjusted the reimbursement owed to a provider, ...
May 2, 2024
Orange County/Sedgwick Inflict MPN Mayhem
How much of California workers’ comp dysfunction directly results from the effectively ungoverned Medical Provider Network (MPN) system? California does not furnish an...
May 1, 2024
Orange County/Sedgwick: Preposterous MPN Telehealth Claim
What in the name of comp are the County of Orange and Third-Party Administrator (TPA) Sedgwick up to? As reported previously, Sedgwick insists Orange County will refus...
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Apr 30, 2024
Despite Orange County/Sedgwick Whims, Telehealth Is Payable
In this second look at the County of Orange’s refusal to pay for telehealth treatment, we pose a critical question: What kinds of chaos will be unleashed if Orange Cou...
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Apr 29, 2024
Orange County & Sedgwick "No Telehealth" Policy
According to Third-Party Administrator (TPA) Sedgwick, the County of Orange refuses to reimburse providers for treating injured employees via telehealth.Sedgwick claim...
Apr 19, 2024
Sedgwick: IBR Filing Fee Hall of Shame
The good news: When Independent Bill Review (IBR) overturns an improper payment denial, Sedgwick Claims Management, Inc. will restore the $180 filing fee the provider ...