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medical-legal
May 10, 2022
2 min read
0
PPO Discounts STILL NOT Applicable to Med-Legal
It’s hard to believe we still have to write this — or is it? California claims administrators may not apply Preferred Provider Organization (PPO) reductions to physici...
Apr 27, 2022
3 min read
0
CA Med-Legal How-To: Collect Penalty & Interest Payments
California physician evaluators, be advised: when claims administrators are late in paying for Medical-Legal services, penalty and interest payments apply. However, inadequat...
Apr 27, 2022
3 min read
0
CA Med-Legal: $76 Million Owed For Record Review in First Year
It’s been just over a year since California adopted the new Medical-Legal Fee Schedule (MLFS). Effective April 1, 2021, the new MLFS represented the first incre...
Apr 21, 2022
3 min read
0
ESIS Continues to Refuse Payment for Med-Legal Evaluations
Third-party claims administrator (TPA) ESIS systematically refuses to pay bills for Medical-Legal services. Full stop. Below, we list 9 Medical-Legal bills — some more...
Apr 19, 2022
3 min read
0
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...
Apr 7, 2022
4 min read
0
CA Med-Legal: How to Appeal Unpaid AME Modifier -94
Regularly, California workers’ comp claims administrators incorrectly deny Medical-Legal Fee Schedule (MLFS) modifier -94 for Agreed Medical Evaluator (AME) services. In this...
Mar 31, 2022
4 min read
0
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...
Mar 29, 2022
3 min read
0
ESIS Unpaid Medical-Legal Bills
Alert: ESIS has failed to pay at least 7 bills for workers’ comp Medical-Legal services, despite acknowledging receipt of the bills in question. Further, attempting to...
Feb 10, 2022
4 min read
0
CA Med-Legal: How to Bill for 10K+ Pages/Units of MLPRR
To help demystify California Medical-Legal record review billing code MLPRR, daisyBill published an MLPRR guide for California physician evaluators. Our ...
Feb 9, 2022
4 min read
0
ESIS Refuses to Answer Phone or Pay Med-Legal Doctor
ESIS, a third-party administrator (TPA) for Ace American Insurance, is failing miserably in its legal duty to timely reimburse a California physician evaluator for Medical-Le...
Feb 7, 2022
3 min read
0
CA Med-Legal Reports: REQUIRED Physician Verification
Last spring, California introduced a new Medical-Legal Fee Schedule (MLFS). Since April 2021, daisyBill clients have submitted over 80,000 medical-legal bills where the new M...
Feb 4, 2022
4 min read
0
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...
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