Explanation of Review

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...

CNA, Crum & Forster, County of San Diego: e-EORs Not Optional

As California continues its transition to fully paperless workers’ comp billing and payment, some claims administrators have apparently decided to follow their own regulation...

Mitchell Unresolved EOR Mess

A persistent glitch in Mitchell’s bill review service is causing revenue management chaos for providers. For second review appeals, providers receive electronic explanations ...

Sedgwick Still Reimbursing at 2018 Rates for California

Since the beginning of 2019, Sedgwick CMS has incorrectly used the 2018 Physician Fee Schedule to reimburse providers. Our data indicates that Sedgwick is consistently and in...

VPay Error Impacts Thousands of Sedgwick EORs

VPay, a payment processing company which issues explanation of reviews (EORs) and virtual credit card payments from claims administrators to providers, suffered a technical g...

Electronic EORs for Workers’ Comp: Timing and Compliance

This month, we’ve placed an emphasis on analyzing and explaining the vagaries of electronic billing for California workers’ compensation medical bills. The state’s Division o...