claims administrators

York Misses the Mark: Paying 2019 Bills at 2018 OMFS Rates

Not one to avoid the spotlight, York Risk Services joins Sedgwick CMS in incorrectly applying the 2018 Physician Fee Schedule rates to services rendered in 2019. Our data sho...

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....

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...

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...

IBR Accountability: Claims Admins Fail to Pay Providers

California regulations mandate that when Independent Bill Review (IBR) overturns a claims administrator’s incorrect bill denial or adjustment and finds in favor of the provid...

Data: Excessive Workers’ Comp Claim Denials Backfire

An industry study tells an interesting story about workers’ compensation claims. A significant upward trend in denials ultimately cost employers and their claims administrato...

Don't Rely on Claims Administrators. Providers Must Know The Rules.

Repeatedly, we hear some version or another of the same story: a provider reaches out to a claims administrator for information regarding workers’ comp billing and payment. T...

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...

Denials/Reductions for Insufficient E/M Documentation Continue

We recently warned providers about an emerging trend among California workers’ comp claims administrators: denying payment for Evaluation and Management (E/M) services in the...

Clearinghouses Under the Microscope: CorVel Corporation

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

CorVel Error: Incorrectly Reimbursed ASC Services

CorVel Corporation, a national third-party administrator, incorrectly reimbursed multiple California workers’ comp providers for Ambulatory Surgical Center (ASC) services, at...