medical-legal

Warning: ESIS (Still) Ignoring CA Medical-Legal Bills

How else can we put this? Sometimes ESIS, a Third-Party Administrator (TPA), just flat-out ignores bills for Medical-Legal services. Below, daisyBill documents how ESI...

(Free, Transparent) CA Med-Legal Fee Schedule Data

As the California Workers’ Compensation Institute (CWCI) peddles paid access to its insurer-derived data and white-tie webinars, daisyBill would like to offer an update on th...

CA Med-Legal Fees, QMEs Under Attack

A recent study on the current Medical-Legal Fee Schedule (MLFS) has triggered a wave of pearl-clutching by payer advocates. So what has the payer-side pundits groping for the...

DWC Seeks QMEs for October Exam

California’s Division of Workers’ Compensation (DWC) is accepting applications from physicians for the October 2022 Qualified Medical Evaluator (QME) exam.The in-perso...

Med-Legal: Cannon Cochran Denies Payment for Interpreter Services

Medical-Legal physician evaluators, be advised: a disturbing payment denial tactic is catching on among California claims administrators. When responding to physician ...

Free: CA Med-Legal "Superbills"

Medical-Legal billing for California workers’ comp is fraught with complications, contradictions, and — of course — threats to physician revenue from less-than-scrupulous ent...

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...

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...

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...

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...

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...

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...