Second Review

City and County of San Francisco's Misleading Response in PPO Discount Dispute
Apr 5, 2021
City and County of San Francisco's Misleading Response in PPO Discount Dispute
Recently, a DaisyBill provider disputed a reduction in reimbursement from the City and County of San Francisco (CCSF) for treating an injured employee. In the Explanation of ...
Broadspire Knows No Law But Its Own
Apr 2, 2021
Broadspire Knows No Law But Its Own
Broadspire continues to break the rules, seemingly confident that California regulators will not hold the claims administrator to account. For months, we reported on B...
Broadspire Employers: Audit Complaint Filed With DWC
Oct 21, 2020
Broadspire Employers: Audit Complaint Filed With DWC
In a recent article, Broadspire Defies CA Law and Denies Appeals Sent by Providers, we described Broadspires’ success in defying California workers’ comp laws without consequ...
DaisyBill Automates Zurich Second Review Appeals
Oct 21, 2020
DaisyBill Automates Zurich Second Review Appeals
DaisyBill recently broke the story (after receiving multiple reports from the DaisyBill community and beyond) that Zurich has improperly denied California providers’ bills fo...
When Zurich Speaks, Garbled Noncompliance Comes Out
Oct 20, 2020
When Zurich Speaks, Garbled Noncompliance Comes Out
We are writing about Zurich again, as the claims administrator’s conduct continues to be a symptom of the deep unfairness that permeates California’s workers’ comp system. Th...
Zurich: Triples Down on Foul Play
Oct 15, 2020
Zurich: Triples Down on Foul Play
Clearly Zurich fears no recourse as it continues to systematically ignore rules while stripping California providers of proper reimbursement. In this latest development, Zuri...
Gallagher Bassett: Audit Complaint Filed With DWC
Oct 7, 2020
Gallagher Bassett: Audit Complaint Filed With DWC
In a previous article, we demonstrated how Gallagher Bassett ignores the California-mandated workers’ comp Official Medical Fee Schedule (OMFS). Gallagher Bassett also ignore...
Broadspire Defies CA Law and Denies Appeals Sent by Providers
Oct 6, 2020
Broadspire Defies CA Law and Denies Appeals Sent by Providers
Broadspire, A Crawford Company, is another example of a claims administrator that disregards California regulations with impunity. After accepting a compliant and time...
Zurich: CORRECT Appeal Instructions for Zurich Denials
Oct 5, 2020
Zurich: CORRECT Appeal Instructions for Zurich Denials
Today, we explain the COMPLIANT protocol for California providers to dispute the noncompliant denials that Zurich recently issued, and that were based on its completely nonco...
Zurich Further Jeopardizes Providers' Payment With Incorrect Appeal Instructions
Oct 2, 2020
Zurich Further Jeopardizes Providers' Payment With Incorrect Appeal Instructions
Even when there is potential payer fraud, California requires the provider -- not the payer -- to shoulder the burden of correcting claims administrator “mistakes.” For the t...
Gallagher Bassett Sinks Second Review Appeals
Sep 21, 2020
Gallagher Bassett Sinks Second Review Appeals
For California workers’ comp providers, we encourage submitting Second Review appeals when the claims administrator incorrectly adjusts or denies payment. Below we sho...
$47 Million and Counting: Second Review Saves Provider Revenue
Mar 6, 2020
$47 Million and Counting: Second Review Saves Provider Revenue
California workers’ comp providers face an inexcusable amount of hassle, red tape, and outright abuse in the struggle to collect correct reimbursement. Take it from us...