Third-party Administrator

City of LA Switches TPAs to Sedgwick and Intercare

The City of Los Angeles changed the Third-Party Administrators (TPAs) that handle workers’ compensation claims for its various departments and offices. Sedgwick Claims...

Gallagher Bassett Bounces Foster Farms Check

You read that headline right.Doctors may need to pin a notice on the wall next to the cash register, as a warning that Gallagher Bassett, a third-party claims administ...

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...

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...

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...

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...

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...

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...

📬 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...

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...

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...

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...