Explanation of Review

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' ...

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...

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...

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 (...

NY Data: Payers That Fail to Respond to Providers' e-Bills

Since August 2025, New York has required workers’ comp medical providers to send their workers' comp bills electronically (e-bills). Since October 2021, the New York W...

Taxpayers Beware: Anaheim Misreports Payment Data

Citizens of Anaheim, CA, may want to examine the city’s books closely, given the suspicious accounting of taxpayer dollars designated for the care...

Liberty Mutual's Ongoing e-EOR Violations Hurt Employers

Liberty Mutual’s ongoing failure to consistently adhere to California workers’ comp regulations should raise concerns for employers and healthcare providers. Despite c...

Liberty Mutual: 7,369 Audit Complaints Filed With the CA DWC

Liberty Mutualfails to uphold its obligations to workers’ compensation providers, making it even more challenging for providers to treatinjured workers. All...

Fresno USD Fails to Comply with Electronic Billing Regulations

For providers treating injured workers, electronic billing is by far the best billing option. For claims administrators in California, it’s not optional at all; accepting ele...

York (aka Sedgwick) Fails Math: EORs Literally Don't Add Up

York Risk Services, which was acquired this month by Sedgwick, has significant math troubles. York recently returned Explanations of Review (EORs) which obfuscated the effect...