EOR

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

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

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

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

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

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

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

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)

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

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...