EORs
Apr 11, 2024
Santa Clara County Deletes Provider's Bills
The County of Santa Clara, a public self-insured employer, employed an odd tactic to resolve bills it had trouble processing: reportedly, they simply deleted the bills.
Oct 18, 2023
Sedgwick: 13,248 Audit Complaints Filed With CA DWC
In keeping with years of consistent violations of California laws and regulations, Sedgwick Claims Management Services continues to fail to send mandatory electronic Explanat...
Aug 11, 2021
Sedgwick: Sketchy EOR Math for LA Unified School District
Sedgwick recently returned an Explanation of Review (EOR) that failed to fulfill a crucial requirement: showing how Sedgwick actually calculated the reimbursement amount paid...
Feb 11, 2021
Payer Refuses to Send Electronic EORs Despite Clear Law
The California law regarding electronic explanations of review (EORs) is crystal clear and completely unambiguous -- at least to the vast majority of the workers’ comp commun...
Nov 18, 2019
City of Los Angeles Neglects Its Duty
The City of Los Angeles (LA) is a self-insured, self-administered employer. This means that the city assumes all of the responsibilities of a claims administrator to complian...
Nov 12, 2019
Markel First/Midwest EORs Leave Providers in the Dark
Electronic Explanations of Review (EORs) from Markel First and Midwest Insurance are missing crucial pieces of information. Key required elements like patient names and Socia...
Oct 17, 2019
York EORs Create Revenue Management Headaches
York Insurance has repeatedly reported incorrect payment amounts in recent Final Explanations of Review (EORs), which are issued in response to second review appeals. These F...