IBR
CA SCIF Baits & Switches MD Out of Payment
Sep 7, 2022
CA SCIF Baits & Switches MD Out of Payment
Once again, California’s State Compensation Insurance Fund (SCIF) may profit by exploiting a flaw in California’s Independent Bill Review (IBR) system.SCIF initially d...
IBR: Sedgwick Ordered to Pay QME $20k+ for False Med-Legal Denial
Sep 7, 2022
IBR: Sedgwick Ordered to Pay QME $20k+ for False Med-Legal Denial
Sedgwick Claims Management Services just set a dubious new record. Maximus, the entity which conducts Independent Bill Review (IBR) on behalf of California’s Division of Work...
SCIF: Med-Legal IBR Chicken Champion
Jul 27, 2022
SCIF: Med-Legal IBR Chicken Champion
Welcome to another round of IBR Chicken, where California claims administrators (falsely) deny payment for the treatment of injured workers for implausible reasons — and keep...
SCIF Stiffs Doc by Paying AFTER Request for IBR
Jul 12, 2022
SCIF Stiffs Doc by Paying AFTER Request for IBR
In a classically underhanded move, California’s State Compensation Insurance Fund (SCIF) twice denied payment for the authorized treatment of an injured worker, but then sudd...
Sedgwick Asserts CA "Loosened" Appeal Process
Jun 28, 2022
Sedgwick Asserts CA "Loosened" Appeal Process
California workers' comp is — supposedly — governed by laws, enacted by the state legislature, and carried out by the Division of Workers’ Compensation (DWC). For disputes ov...
CA: Employer Authorization Is Ultimately Worthless
Jun 23, 2022
CA: Employer Authorization Is Ultimately Worthless
California law mandates that once an employer authorizes treatment for an injured worker, that authorization may not be rescinded “for any reason,” theoretically guaranteeing...
Sedgwick: Gruesome and Abusive IBR Games
Jun 15, 2022
Sedgwick: Gruesome and Abusive IBR Games
In California workers’ comp, providers cannot rely on authorization to guarantee payment — despite what the law says. Today’s article shows exactly how a claims administrator...
Hurray! Proposed IBR Changes Benefit Doctors
Jun 8, 2022
Hurray! Proposed IBR Changes Benefit Doctors
Proposed legislation in California would allow the state’s Independent Bill Review (IBR) organization (Maximus) to invoice the payer (aka claims administrator) for the review...
Med-Legal IBR: Maximus Denies Documented Interpreter Reimbursement
Apr 19, 2022
Med-Legal IBR: Maximus Denies Documented Interpreter Reimbursement
In a perfect example of California’s failing Independent Bill Review (IBR) process, Maximus (California’s designated IBR organization) abandoned all semblance of lawfulness a...
Farmers Insurance: Winning "IBR Chicken”
Mar 31, 2022
Farmers Insurance: Winning "IBR Chicken”
California workers’ comp technically offers an appeals process for providers to dispute incorrect reimbursements. However, this appeals process actually encourages claims adm...
PPO: No Provider Recourse for Unnamed Discounts
Mar 22, 2022
PPO: No Provider Recourse for Unnamed Discounts
In California workers’ comp, the appeals process for disputing improper Preferred Provider Organization (PPO) reductions has a serious flaw.Routinely, Explanations of ...
CA Workers' Comp: Appeals Rigged to Profit Payers
Mar 21, 2022
CA Workers' Comp: Appeals Rigged to Profit Payers
When a claims administrator incorrectly reimburses a California workers’ comp provider, the mandated process for the provider to dispute the error (or purposeful theft) is co...