EOR

CA: West Bend Insurance's EOR Non-Compliance

West Bend Insurance Company (WBIC) is not among the largest payers in our systems, handling less than 500 of our providers’ bills annually. That doesn’t ...

Sedgwick Continues to Fail FedEx (and CA Providers)

FedEx is a massive American company with over half a million employees. The shipping giant has chosen to entrust Sedgwick Claims Management Services, Inc...

Sedgwick’s Sloppy Handling of Starbucks Claims

Is Sedgwick Claims Management Services, Inc. even trying?The Third-Party Administrator (TPA) is the largest in workers’ comp, managing claims for a massive portfolio o...

FedEx: Sedgwick & Genex Bungle Payment (Again)

Once again, Third-Party Administrator (TPA) Sedgwick Claims Management Services authorized treatment for an injured FedEx employee, only to refuse to pay for it. More concern...

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 IBR Chicken 2.0: Gallagher Bassett and JPMorgan Turn IBR Into a Provider Trap

Gallagher Bassett, one of the largest Third-Party Administrators (TPAs) in the country, and its vendor, JPMorgan, may be derailing California providers' ...

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 Stiffs QME With “Denial Dump” EOR

Sedgwick Claims Management Services, Inc. is raking in profits one unpaid bill at a time through non-compliance, invalid denial reasoning, ...

Hyatt: Gallagher Bassett Stiffs Provider With "Denial Dump" EOR

Why provide one baseless, nonsensical reason for refusing to pay a provider when you can provide 10? That’s the approach Gallagher Bassett took when it improperly deni...

Clearinghouse: Data Dimensions Clients' e-EOR Problem

With the receipt of electronic Explanations of Review (e-EORs), providers realize the full benefits of workers’ comp e-billing. e-EORs furnish payment data that automatically...

daisyBill Takes Sedgwick Complaints to CA DWC Administrative Director

It may be a new year, but it’s the same ol’ Sedgwick. However, the California Division of Workers’ Compensation (DWC) has indicated it may take a different (and hopefu...

Berkshire Hathaway: 10,735 Audit Complaints Filed With CA DWC

Berkshire Hathaway Homestate Companies (BHHC) is backsliding into old, bad habits.Over the summer, BHHC failed to send thousands of electronic Explanations of Review (...