e-EOR

Audit Complaint: CA DWC Must Address Gallagher Bassett Violations

Gallagher Bassett is violating California law and regulations through its vendor, InstaMed. The Third-Party Administrator (TPA)’s non-compliance i...

CA: JPMorgan’s InstaMed Leaves Gallagher Bassett Out of Compliance

Third-Party Administrator (TPA) Gallagher Bassett has failed to send electronic Explanations of Review (e-EORs) in response to thousands of providers’ electronic bills (e-bil...

Paradigm’s 96-Page “Frankenstein” EOR Covers ~400 Bills

Paradigm Specialty Networks created a 96-page Frankenstein’s monster of an Explanation of Review (EOR), stitched together from hundreds of bills for mult...

CA: Sedgwick Hits 359,626 Violations (and Counting)

Sedgwick Claims Management Services, Inc. is routinely non-compliant with California workers' comp payment laws and regulations. Among its violations: repeatedly faili...

ESIS e-EOR Compliance Nosedives; Vendors Step Up to Help

Third-Party Administrator (TPA) ESIS recently switched bill review vendors, which unfortunately delayed the delivery of thousands of electronic Explanations of Review (e-EORs...

Sedgwick Authorizes FedEx Care. Then Stiffs the Provider.

Third-Party Administrator (TPA) Sedgwick Claims Management Services authorized treatment for an injured FedEx employee — and then refused to pay for it. Worse, Sedgwick won't...

CCMSI e-EOR Violations Create Chaos for Providers

In California and other states, payers must respond to providers' electronic bills (e-bills) with electronic Explanations of Review (e-EORs), which automatically post payment...

accūrō Solutions: Proactive Bill Review Improves Compliance for Payers

It’s not all bad news in the world of workers’ comp billing. While daisyNews regularly holds payers and their vendors accountable for their failures, some companies de...

NYSIF e-EOB Non-Compliance Rises in 2025

The New York State Insurance Fund (NYSIF) is making it harder for providers to treat the state’s injured workers by repeatedly failing to comply with payment requirements for...

Adminsure Billing Nightmare: Public Pays the Price for Friction (Part 2)

In Part 1 of our exposé on Adminsure, we detailed the painful odyssey providers must endure just to confirm payment for the treatment of injured workers.Below, we spot...

Adminsure Makes Billing a Nightmare for Providers (Part 1)

Adminsure is a prime example of why providers hesitate to treat injured workers.In multiple cases, Adminsure compliantly sent an electronic Explan...

Sedgwick Hits 298,034 Violations (and Counting)

Sedgwick Claims Management Services, Inc. continues to violate a critical California payment requirement with apparent impunity. The Third-Party Administrator (...