When reducing bill payment below the rates allowed by the California Official Medical Fee Schedule (OMFS), in the Explanation of Review (EOR) claims administrators must specify the entity with which the provider has a written contract establishing the claim’s administrator's right to PPO discounts.
Most EORs label the column showing PPO discounts with some variation of “PPO Reduction” or “PPO Savings.”
Examples of where to find the PPO Name
Sedgwick Claims Management Services
State Compensation Insurance Fund (CA)
Liberty Mutual Insurance
Zurich Insurance North America
Berkshire Hathaway Homestate Companies
Tristar Risk Management
Intercare Holdings Insurance, Inc.
AmTrust North America
Cannon Cochran Management Services Inc.
Insurance Company of the West
Keenan & Associates
Employers Compensation Insurance Company