Third-party Administrator
Jan 23, 2022
Gallagher Bassett (Zurich) Check Bounces
Gallagher Bassett is having a rough — and embarrassing — week. After bouncing a check for Foster Farms, the third-party claims administrator (TPA) bounced another, bigger che...
Sep 28, 2021
TPA Changes: City of Alameda, Torrance Unified Schools
Two California public employers switched third-party administrators (TPA) recently, affecting bills for all dates of service. The City of Alameda and the Torrance Unified Sch...
Aug 23, 2021
ESIS Fails to Pay IBR Fee on Behalf of ABM Industries
Ask yourself — what happens if you’re a year late paying a bill?Your credit score tanks? Your car is repossessed? Your home foreclosed on? In most walks of life...
Nov 3, 2019
Bill Review Highlight: Definiti Healthcare Management
Over the last several years, providers have sent over 5.2 million workers’ comp bills from DaisyBill. These millions of bills allow DaisyBill to directly witness the manageme...
Jul 11, 2019
TPA Alert: LA County Switches Claims Administrators
Effective July 1, 2019, the County of Los Angeles is no longer utilizing third-party claims administrator (TPA) TriStar Risk Management. Claims are transferred to eith...
May 9, 2019
The Conco Companies Changes TPA
The Conco Companies is no longer using Athens as its Third Party Administrator (TPA). Effective 4/1/2019, Travelers will be handling all claims for The Conco Companies...
Mar 1, 2019
📬 Payer Responses: Guile, Waiting, and Crickets 🏏
Today we report on the responses from Sedgwick, Liberty Mutual, York, and State Compensation Insurance Fund (SCIF), following our posts detailing their systematic underpaymen...
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 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...
Feb 6, 2019
York Misses the Mark: Paying 2019 Bills at 2018 OMFS Rates
Not one to avoid the spotlight, York Risk Services joins Sedgwick CMS in incorrectly applying the 2018 Physician Fee Schedule rates to services rendered in 2019. Our data sho...
Feb 5, 2019
State Farm Workers’ Comp Claims Moved to Sedgwick CMS
Time to start counting your poultry -- State Farm’s workers’ compensation henhouse is now guarded by the third-party administrator (TPA) Sedgwick, effective October 21, 2018....
Feb 1, 2019
Sedgwick Still Reimbursing at 2018 Rates for California
Since the beginning of 2019, Sedgwick CMS has incorrectly used the 2018 Physician Fee Schedule to reimburse providers. Our data indicates that Sedgwick is consistently and in...