Third-party Administrator
May 27, 2025
Helmsman Makes Ransom Demand for Refund Request (Part 3)
Helmsman Management Services, LLC, a Third-Party Administrator (TPA), has refused to process a Second Review appeal submitted by a California physician who treated an ...
May 16, 2025
Diabolical Discounts: Ralphs Pays MD $44 to Treat Injured Worker
Our weekly “Diabolical Discounts” features the most atrocious examples of the low reimbursements doctors receive for treating California’s injured workers.<...
May 12, 2025
Sedgwick Stiffs Doctors, County of LA Taxpayers Pick Up the Tab
Sedgwick Claims Management Services, Inc. has made it a business practice to defy California workers’ compensation laws, and public entities like the County of ...
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May 8, 2025
Helmsman Botches NBC Injury Claim—Underpays Doctor, Demands Refund Anyway (Part 2)
As daisyNews reported yesterday, Helmsman Management Services, LLC attempted to claw back payment from a California provider for plainly bogus reasons. We debunked those reas...
May 7, 2025
Helmsman's Ridiculous Refund Request (Part 1)
Why do so many doctors avoid treating injured workers? We have a perfect illustration from Helmsman Management Services LLC. This Third-Party Administrator (TPA) recently:
Nov 11, 2024
CA: USC Switches Workers' Comp TPA
The University of Southern California (USC), a self-insured employer, has switched the Third-Party Administrator (TPA) it uses to handle workers’ comp claims for its injured ...
Oct 29, 2024
CA Alert: ESIS e-Bill Rejections (and What to Do)
Third-party administrator (TPA) ESIS is improperly rejecting valid e-bills from California providers, citing an inexplicable, seemingly random (and definitely non-compliant) ...
Jul 9, 2024
Sedgwick <> Data Dimensions - Married or Divorced?
Sedgwick Claims Management Services, a Third-Party Administrator (TPA), and Data Dimensions, a clearinghouse vendor, may have gotten hitched.Imagine our surprise when ...
Apr 18, 2024
C'mon, Sedgwick: TPA Tries PPO Discount for Med-Legal (Again)
We’ll say it as often as we have to: Preferred Provider Organization (PPO) discounts do not apply to bills for Medical-Legal services. It’s a lesson that Sedgwick Clai...
Mar 12, 2024
daisyBill Takes Sedgwick Complaints to CA DWC Administrative Director
It may be a new year, but it’s the same ol’ Sedgwick. However, the California Division of Workers’ Compensation (DWC) has indicated it may take a different (and hopefu...
Apr 27, 2023
Sedgwick Racks Up 79,318 DWC Audit Complaints
Third-Party Administrator (TPA) Sedgwick Claims Management Services, Inc. continues to ignore California workers’ comp billing regulations with impunity.Currently, Sed...
Sep 7, 2022
MGM Resorts Claims Administrator Guide
Billing for the treatment of injured MGM Resorts employees can get complicated. That’s because MGM uses a combination of insurance companies and Third-Party Administrators (T...