claims administrators
Jul 6, 2021
IBR Hall of Shame: Sedgwick Sets New Standard of Noncompliance
Sedgwick failed to comply with an Independent Bill Review (IBR) ruling for almost four months. Worse, the payor’s brazenness is likely to go unpenalized by the state.T...
May 12, 2021
CNA Repeatedly Ignores California Law
By law, claims administrators must remit payment for Medical-Legal services within 60 days of receiving the physician’s bill. As of this writing, payment to one physician fro...
May 5, 2021
Athens Must Stop Taking Unnamed PPO Discounts
As advocates for a fair and just workers’ comp system, we here at DaisyBill feel compelled to remind insurer Athens Administrators of an important fact about California worke...
May 4, 2021
CCSF Stands Up On Behalf of Providers
Many payers delegate bill review to an outside entity, trusting the bill review vendor to properly reimburse providers. But when a provider disputes a denial or adjustment, i...
Apr 29, 2021
Introducing: CA Med-Legal Fee Schedule Report Cards
At DaisyBill, we strive to help providers and their staff navigate the complexities of workers’ comp billing and payment, to ensure proper reimbursement. To that end, we’re d...
Apr 27, 2021
California MPNs: Camouflage for Discounts and Denials
Medical Provider Networks (MPNs) are under fire — as they should be.Far too often, Calforina claims administrators (aka ‘payers’) use MPNs — and providers’ unfamiliari...
Apr 2, 2021
Broadspire Knows No Law But Its Own
Broadspire continues to break the rules, seemingly confident that California regulators will not hold the claims administrator to account. For months, we reported on B...
Mar 30, 2021
Zurich Denies Liability After Accepting Liability
Zurich recently denied liability for an injured workers’ treatment, claiming the 2003 injury was not work-related — despite the fact that Zurich already authorized the treatm...
Mar 25, 2021
Travelers, SCIF Incorrectly Apply New E/M Rules Before Effective Dates
Every year, we see claims administrators incorrectly deny reimbursement because they fail to keep up with the latest changes to the Official Medical Fee Schedule (OMFS). But ...
Mar 24, 2021
IBR Hall of Shame: Employers
Employers Holdings set a shameful new standard of indifference with regard to promptly and correctly reimbursing providers. The insurer incorrectly denied payment, disregarde...
Mar 12, 2021
Gallagher Bassett, Foster Farms Lay A Rotten Egg in CA
Update: As of April 1, 2021 Gallagher Bassett can locate and process claims for Foster Farms employees. Workers’ compensation claims for injured employees of Foster Fa...
Mar 2, 2021
ESIS + Conduent + StrataCare = Provider Torment
Preferred Provider Organizations (PPOs) profit from reducing the reimbursements providers receive for treating injured workers. Yet, we would argue that providers (and injure...