IBR

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

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

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”

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

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

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...

CA DWC Rigs IBR and Helps SCIF

A doctor treated a California injured worker. Subsequently, in an apparent attempt to avoid paying for the treatment, the State Compensation Insurance Fund deni...

MLPRR: Costco/Helmsman Play Med-Legal IBR Chicken

Call it “IBR Chicken: MLPRR Edition.” Third-party claims administrator (TPA) Helmsman, acting on behalf of self-insured employer Costco, refused to reimburse a physici...

Berkshire Hathaway: DWC Targeted Audit Needed ASAP

As Berkshire Hathaway HomeState Companies (BHHC) persists in its failure to compliantly process thousands of valid Second Review appeals, the California Divisio...

Berkshire Hathaway Ignores THOUSANDS of Second Review Appeals (& CA Law)

Berkshire Hathaway Homestate Companies (BHHC) continues to fail to compliantly process valid Second Review appeals submitted by California doctors to dispute erroneously deni...

IBR Chicken: SCIF Blinks Too Late

You win some, you lose some. That’s the lesson the State Compensation Insurance Fund (SCIF) must take from the latest round of California workers’ comp claims administ...

Intact Insurance Plays (Double) IBR Chicken

Welcome to another round of IBR Chicken! The rules are simple. To avoid reimbursing a doctor for authorized workers’ comp services, a California claims administrator m...