Very Late Request from MAXIMUS (California)

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Very Late Request from MAXIMUS (California)

Postby suekarp on Tue Mar 10, 2015 11:11 am

I thought that I would throw this out to see what thoughts that everyone may have regarding an appropriate response to the "Notice of Assignment and Request for Information" that we just received. Here is the timeline:

Date of injury: 5/17/1999
RFA: 12/24/2013
UR Denial: 12/26/2013
IMR Application Received: 1/6/2014
Notice of Assignment and Request for Information: 3/5/2015

In the past year or so, we have gone on to authorize the requested treatment, and even more.

I did not get a copy of the Application for IMR, so I don't even know if it was the applicant or her attorney that filed it. I have sent the applicant attorney a fax of the Notice of Assignment, asking him to withdraw the Application for IMR. I am not sure that I will hear back from him, though.

Suggested responses to MAXIMUS? (now, be nice....) I am not making this up, either.
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Re: Very Late Request from MAXIMUS (California)

Postby LawAdvocate on Wed Mar 11, 2015 8:42 am

Request withdrawal with proof treatment was already authorized. Happens frequently.
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Re: Very Late Request from MAXIMUS (California)

Postby suekarp on Thu Mar 12, 2015 6:21 am

Law,
Does it really happen that the MAXIMUS request comes so very much after the fact?
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Re: Very Late Request from MAXIMUS (California)

Postby LawAdvocate on Fri Mar 13, 2015 9:20 am

Yes, they do not seem to be more compelled than a state agency to hire enough people and assure they are meeting the law's deadline, yet they keep dropping that price.
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Re: Very Late Request from MAXIMUS (California)

Postby bakodoc on Sun Mar 15, 2015 12:26 am

Odd... Maximus just hired something like 5-700 reviewers to go live last July in order to catch up and announced that they'd be caught up by late 2014 and provide timely reviews with 45 days of the request. I personally know a high volume reviewer for Maximus and I remember him telling me they were about a year behind last summer. It's odd that they are still a year behind with all the new reviewers added.

As far as Maximus lowering the fee goes, they are under the pressure because they nearly lost their bidding last year for 5 additional years of contract. The other bidders came in with less than half what Maximus was proposing to charge. I think it's still way over priced. They are charging 3-400 to just sort and process the request and distributing it to the reviewer. That's just too excessive. CID Management bid $190 all inclusive charge per case which includes the reviewer fee. CA WC is a gravy train for Maximus in my opinion and something stinks bad that while Maximus was failing to meet the state requirement after 2 years of service, they were still able to get experience points and win the bid for contract until 2020.
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