claims administrators
Feb 20, 2019
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...
Feb 15, 2019
Liberty Mutual Trifecta of Incorrect Payments
In this, our fourth story on the fiasco of 2019 workers’ comp payments, we turn to the errors of Liberty Mutual. By now, from reading about Sedgwick, York, and Sedgwick (agai...
Feb 8, 2019
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...
Feb 6, 2019
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...
Feb 5, 2019
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....
Feb 1, 2019
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...
Nov 8, 2018
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...
Sep 25, 2018
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...
Aug 31, 2018
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...
Aug 30, 2018
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...
Aug 24, 2018
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 ...
Aug 23, 2018
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...