EOR
Data! Top 10 Claims Admins: CA Electronic EOR Compliance
Sep 15, 2022
Data! Top 10 Claims Admins: CA Electronic EOR Compliance
Electronic Explanations of Review (e-EORs) are a non-negotiable requirement of workers’ comp electronic billing. Within 15 working days of receiving a provider’s e-bill, the ...
Berkshire Hathaway Repairs Electronic EOR Issue
Sep 15, 2022
Berkshire Hathaway Repairs Electronic EOR Issue
There’s no excuse for claims administrators not to accept and properly process electronic bills, a legal requirement in California for almost 10 years now. Ever...
AmTrust Addresses Electronic EOR Issue
Sep 15, 2022
AmTrust Addresses Electronic EOR Issue
Insurer AmTrust North America provided an excellent example of how claims administrators, working in good faith with providers, can resolve Electronic Data Interchange (EDI) ...
Adminsure (Promptly) Fixes EOR Glitch
Sep 7, 2022
Adminsure (Promptly) Fixes EOR Glitch
Third-Party Administrator (TPA) Adminsure recently offered a perfect example of how workers’ comp can work beautifully when claims administrators take their responsibilities ...
SCIF Blames Anthem for Late Payments
Jul 12, 2022
SCIF Blames Anthem for Late Payments
California’s State Compensation Insurance Fund (SCIF) consistently fails to timely pay doctors for the care of injured workers. Between January 1 and June 15 of 2022, SCIF ig...
Sedgwick Late e-EORs: 13,999 Audit Complaints Submitted
Jun 23, 2022
Sedgwick Late e-EORs: 13,999 Audit Complaints Submitted
Sedgwick Claims Management Services is breaking the law. We encourage the California Division of Workers’ Compensation (DWC) to assert its role in upholding workers’ comp law...
Sedgwick Missing e-EORs: 25,970 Audit Complaints Submitted
Jun 23, 2022
Sedgwick Missing e-EORs: 25,970 Audit Complaints Submitted
Sedgwick Claims Management Services is breaking the law. We encourage the California Division of Workers’ Compensation (DWC) to assert its role in upholding workers’ comp law...
Data: e-EOR Compliance Rates
Jun 1, 2022
Data: e-EOR Compliance Rates
To facilitate electronic billing for workers’ comp, California requires all claims administrators to respond to provider e-bills with electronic EORs (e-EORs). Within 15 work...
AmTrust: Serious Violation of CA e-Billing Law
Apr 15, 2022
AmTrust: Serious Violation of CA e-Billing Law
AmTrust North America refuses to comply with the most basic workers’ comp electronic billing mandates. In that refusal, AmTrust completely undermines the purpose of workers’ ...
How to e-Bill: 835 Electronic EORs
Apr 6, 2022
How to e-Bill: 835 Electronic EORs
California law mandates that when a provider bills electronically for workers’ comp services, the claims administrator must timely send the provider an electronic Explanation...
How to Identify PPO Reductions (Part I)
Mar 16, 2022
How to Identify PPO Reductions (Part I)
Daily, we hear from workers’ comp providers requesting help with identifying whether Pilfering Provider Organizations (aka: PPOs) are hijacking the funds intended to pay for ...
ESIS Refuses to Answer Phone or Pay Med-Legal Doctor
Feb 9, 2022
ESIS Refuses to Answer Phone or Pay Med-Legal Doctor
ESIS, a third-party administrator (TPA) for Ace American Insurance, is failing miserably in its legal duty to timely reimburse a California physician evaluator for Medical-Le...