Med-Legal Fee Schedule Report Cards

Since California’s new MLFS took effect on April 1, 2021, some claims administrators have proven better than others at properly reimbursing new billing codes and modifiers. With our Report Cards, providers can see which claims administrators get Medical-Legal payment right, which get it wrong, and how to appeal incorrect payments.

Questions? Schedule a Call

ML200 - Mitsui Sumitomo Insurance: Grade A

Claims administrator properly processed reimbursement for ML200. Date of Service: 04/02/2021

View Report Card

ML200 - Next Level Administrators: Grade F

Claims administrator failed to properly reimburse ML200. Next Level Administrators incorrectly denied valid medical-legal code as not reimbursable. Date of Service: 04/08/2021

View Report Card

ML204 - Sedgwick Claims Management Services: Grade F

Claims administrator failed to properly reimburse ML204. Sedgwick incorrectly denied valid medical-legal code as “not considered a valid reimbursable code.” Date of Service: 04/09/2021

View Report Card

ML200 - Pacific Compensation Insurance Company: Grade F

Claims administrator failed to properly reimburse ML200. Pacific Compensation Insurance Company incorrectly denied valid medical-legal code as not reimbursable. Date of Service: 04/01/2021

View Report Card

ML200 - Sedgwick Claims Management Services: Grade F

Claims administrator failed to properly reimburse ML200. Sedgwick incorrectly denied valid medical-legal code as “not considered a valid reimbursable code.” Date of Service: 04/01/2021

View Report Card

ML200 - Liberty Mutual Insurance: Grade F

Claims administrator failed to properly reimburse ML200. Liberty Mutual incorrectly denied valid medical-legal code as exceeding fee schedule allowance. Date of Service: 04/05/2021

View Report Card

ML200 - Sedgwick Claims Management Services: Grade A

Claims administrator properly processed reimbursement for ML200. Date of Service: 04/07/2021

View Report Card

ML201 - Benchmark Insurance Company: Grade A

Claims administrator properly processed reimbursement for ML201. Date of Service: 04/01/2021

View Report Card

ML200 - Guard Insurance Group: Grade B

Claims administrator properly processed reimbursement for ML200. The lower grade reflects that the explanation of review (EOR) incorrectly lists 99199 as the ‘Rev./Proc. Code.’ Date of Service 04/05/2021

View Report Card

ML202 - Sedgwick Claims Management Services: Grade F

Claims administrator failed to properly reimburse ML202. Sedgwick incorrectly denied valid medical-legal code as “not considered a valid reimbursable code.” Date of Service: 04/06/2021

View Report Card

ML204 - Contra Costa Schools Insurance Group: Grade A

Claims administrator properly processed reimbursement for ML204. Date of Service: 04/13/2021

View Report Card

ML200 - ESIS, Inc.: Grade A

Claims administrator properly processed reimbursement for ML200. Date of Service: 04/06/2021

View Report Card

ML201 / MLPRR - Broadspire: Grade F

Claims administrator failed to properly reimburse ML201 and MLPRR. Broadspire incorrectly reduced reimbursement by taking a noncompliant PPO reduction. Date of Service: 04/13/2021

View Report Card

ML201 - Sedgwick Claims Management Services: Grade F

Claims administrator failed to properly reimburse ML201. Sedgwick incorrectly denied valid medical-legal code as “not considered a valid reimbursable code.” Date of Service: 04/09/2021

View Report Card

ML201 / MLPRR - Sedgwick Claims Management Services: Grade F

Claims administrator failed to properly reimburse ML201 and MLPRR. Sedgwick incorrectly denied valid medical-legal codes as “not in the fee schedule.” Date of Service: 04/06/2021

View Report Card

ML200 - Benchmark Insurance Company: Grade A

Claims administrator properly processed reimbursement for ML200. Date of Service: 04/02/2021

View Report Card

ML200 - CorVel: Grade A

Claims administrator properly processed reimbursement for ML200. Date of Service: 04/05/2021

View Report Card

ML201 - ESIS, Inc.: Grade A

Claims administrator properly processed reimbursement for ML201. Date of Service: 04/01/2021

View Report Card

ML200 - Berkshire Hathaway Homestate Companies: Grade B

Claims administrator properly processed reimbursement for ML200. The lower grade reflects that the explanation of review (EOR) incorrectly lists 99199 as the ‘Procedure Code/Mod.’ Date of Service: 04/16/2021

View Report Card

ML202 - CorVel: Grade B

Claims administrator properly processed reimbursement for ML202. The lower grade reflects that the explanation of review (EOR) incorrectly lists ML201 as the reimbursed code. Date of Service: 04/19/2021

View Report Card

ML200 - Intercare Holdings Insurance, Inc.: Grade A

Claims administrator properly processed reimbursement for ML200. Date of Service: 04/12/2021

View Report Card

ML200 - Beta Healthcare Group Risk Management Authority: Grade A

Claims administrator properly processed reimbursement for ML200. Date of Service: 04/12/2021

View Report Card

ML201 - Sedgwick Claims Management Services: Grade B

Claims administrator properly processed reimbursement for ML201. The lower grade reflects that the explanation of review (EOR) incorrectly lists 99199 as the ‘Reimbursed Code.’ Date of Service: 04/01/2021

View Report Card

ML200 - Benchmark Insurance Company: Grade A

Claims administrator properly processed reimbursement for ML200. Date of Service: 04/09/2021

View Report Card

ML200 - AmTrust North America: Grade F

Claims administrator failed to properly reimburse ML200. AmTrust incorrectly re-coded ML200 to ML100. Date of Service: 04/02/2021

View Report Card

ML201 - Barrett Business Services Inc.: Grade A

Claims administrator properly processed reimbursement for ML201. Date of Service: 04/09/2021

View Report Card

ML201 - Athens Administrators: Grade F

Claims administrator failed to properly reimburse ML201. Athens incorrectly reduced reimbursement by failing to adjudicate service with Modifier 93. Date of Service: 04/14/2021

View Report Card

ML200 - Sedgwick Claims Management Services: Grade F

Claims administrator failed to properly reimburse ML200. Sedgwick incorrectly denied valid medical-legal code as “not considered a valid reimbursable code.” Date of Service: 04/09/2021

View Report Card

ML200 - Sedgwick Claims Management Services: Grade F

Claims administrator failed to properly reimburse ML200. Sedgwick incorrectly denied valid medical-legal code as “not considered a valid reimbursable code.” Date of Service: 04/02/2021

View Report Card

ML203 - AIG Claims, Inc.: Grade F

Claims administrator failed to properly reimburse ML203. AIG incorrectly denied valid medical-legal code as not in the fee schedule. Date of Service: 04/01/2021

View Report Card

ML200 - CorVel: Grade A

Claims administrator properly processed reimbursement for ML200. Date of Service: 04/20/2021

View Report Card

ML201 - AmTrust North America: Grade F

Claims administrator failed to properly reimburse ML201. AmTrust incorrectly re-coded ML201 to ML102. Date of Service: 04/08/2021

View Report Card

ML203 - AIG Claims, Inc.: Grade F

Claims administrator failed to properly reimburse ML203. AIG incorrectly denied valid medical-legal code as not in the fee schedule. Date of Service: 04/01/2021

View Report Card

intercom_chat_bubble_icon