Lien for medical services- new ins co doesn't have bills (Ca

The filing and enforcement of liens (different states refer to these with different terms) to secure payment for services or goods against a workers' compensation award is complex and filled with special rules - this category is for questions and discussion of this special area of work comp law.

Lien for medical services- new ins co doesn't have bills (Ca

Postby jamiecdar@aol.com on Mon Sep 08, 2014 5:30 pm

Just starting of with a "thanks" for any suggestions and/or advice!
I'm relatively new to resolving liens and have come across several insurance companies that have taken over cases from another insurance carrier. I am told that they do not have the claims/bills for this particular claimant and that I need to send them copies of ALL the bills and supporting documents/reports etc. that contributed to the amount of the lien. I understood that when one insurance company takes over for another, all medical bills/files etc. are transferred and that all medical charts are to be kept for 7 years. I was also told that there is a labor code that addresses this issue and gives specific amounts that are chargeable to duplicate bills/reports. If anyone can help by either directing me to the labor code that gives me information or can clarify the rules/regulations regarding my need to provide copies of everything - I would greatly appreciate it!
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Re: Lien for medical services- new ins co doesn't have bills (Ca

Postby carmenita on Tue Sep 09, 2014 9:55 am

General Information and Instructions - OMFS ground rules

DUPLICATE REPORTS

A primary treating physician has fulfilled his or her reporting duties by sending one copy of a required report to the claims administrator or to a person designated by the claims administrator to be the recipient of the required report. Requests for duplicate reports related to billings shall be in writing. Duplicate reports shall be separately reimbursable. Where the payer requests an additional copy of the reports, the payer shall reimburse for the duplicate report at $10.00 for up to the first 15 pages. Pages in excess of 15 pages shall be reimbursed at $0.25 per page. Charges for duplicate reports shall be billed using code 99087 and are subject to the 5% reduction in fees for physician services. Requests for duplicate reports shall be made only by the claims administrator.
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Re: Lien for medical services- new ins co doesn't have bills (Ca

Postby jamiecdar@aol.com on Tue Sep 09, 2014 12:26 pm

Thank you for the response, I appreciate it! After I read your response, I found that paragraph in the OMFS novel! I'll try that and see what the response from the insurance co. is...I'm sure he will reject/deny it but I'll try anyway.
Thanks again!
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Re: Lien for medical services- new ins co doesn't have bills (Ca

Postby suekarp on Mon Sep 15, 2014 6:52 am

Having been on the receiving end of files transferred from one adjusting agency to another, I can tell you that it is extremely hard to locate specific items in a claims file. The agency that is transferring to a new company typically has at least a several month lead time before the actual transfer takes place. The claim files sometimes get neglected entirely or assigned to temps who may not do a contiencious job of working the files. To further complicate things, many times lost portions of files are sent many weeks or months after the transfer takes place.

For the agency who inherites the files, locating specific documents can be like looking for a needle in a haystack. Because of the behavior of the prior adjusting agency not working the claims as well as they should have, the new adjusting agency frequently receives a lot of angry calls from providers who have not been paid on a timely basis. Even with "paperless" files, sometimes the documents do not trnasfer accurately, or at all.

It is an extremely stressful time for the adjusters, so cutting them just a bit of slack, and understanding what they are going through will get you further in getting your lien paid than being a screamer.
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Re: Lien for medical services- new ins co doesn't have bills (Ca

Postby jamiecdar@aol.com on Tue Sep 30, 2014 3:21 pm

Thank you for your post. I understand the craziness that can happen when files are transferred...or not. ha... I am more the "getting more with honey" type of person and try to deal reasonably with all adjusters/attorneys etc. It is happening more and more though. SCIF now wants copies of ALL reports, PR2's etc. submitted with the patient billing ledger- even though they received everything with the first bill and, as partial payment can verify, they did get it. It just seems like a very tiresome and unnecessary game. We are all just trying to get things taken care of and I subscribe to the idea that things are hard enough without making them harder. Thanks again for your input.
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