Incorrect Denials
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Jan 29, 2024
Sedgwick: 49% of Appeals Incorrectly Denied
Sedgwick Claims Management Services, Inc. is notorious for failing to respond compliantly to California providers’ bills for treating injured workers. But the Third-Party Adm...
Dec 5, 2019
STRONG WARNING! Travelers Refuses to Pay Provider
We advise providers to think carefully before treating injured workers covered by Travelers. Below, we summarize the nightmarish run-around that an MPN provider experienced w...
Jul 2, 2019
Claims Admins Deny Second Review Appeals as Duplicate Bills
Two claims administrators, York and Sedgwick, denied hundreds of compliant second review appeals on the grounds that the appeals were “duplicates” of the Original Bills in qu...
Jun 13, 2019
CA Payors Put the Squeeze on Providers (Again)
In California, box 1a of the CMS 1500 billing form is for the injured worker’s Social Security Number (SSN). When the claims administrator insists the provider populate box 1...
Feb 20, 2019
SCIF (CA) Incorrectly Paying 2018 Fee Schedule for 2019 DOS
It’s SCIF’s turn. The California State Compensation Insurance Fund (SCIF) is also incorrectly reimbursing providers using the 2018 Physician Fee Schedule instead of the corre...
Feb 19, 2019
IBR Appeal Analysis for CPTs 99358 & 99359
**Update: The 2021 OMFS updates drastically changed how E/M codes are billed.*Reimbursements for CPTs 99358 & 99359 are tricky because payers frequently deny reimburse...
Feb 15, 2019
Liberty Mutual Trifecta of Incorrect Payments
In this, our fourth story on the fiasco of 2019 workers’ comp payments, we turn to the errors of Liberty Mutual. By now, from reading about Sedgwick, York, and Sedgwick (agai...
Feb 12, 2019
Maximus Confirms Using Second Review Appeals to Correct Billing Errors
Correcting a coding error is as simple as submitting a Second Review appeal explaining the error. Last year, we discussed the convoluted process to correct billing err...
Feb 8, 2019
The Payment Chaos Continues: Sedgwick Denies Appeal for Correct 2019 Reimbursements
Sedgwick’s payment mistakes multiply. First, Sedgwick incorrectly paid California providers by applying an old workers’ comp fee schedule. Now Sedgwick compounds its error by...
Aug 31, 2018
Data: Excessive Workers’ Comp Claim Denials Backfire
An industry study tells an interesting story about workers’ compensation claims. A significant upward trend in denials ultimately cost employers and their claims administrato...
Jan 24, 2017
Confusion and Running in Circles: AIG / MedRisk Incorrect Denials
Recently DaisyBIll providers reported receiving incorrect and very confusing denials from MedRisk, a managed care provider network, for bills that were actually submitted dir...