Speciality Risk Services Acquired by Sedgwick

According to multiple news sources, in 2011 Sedgwick CMS acquired Speciality Risk Services (SRS) from The Hartford Financial Services Group.

Everest National Insurance

DaisyBill lists Everest National Insurance (Everest) as an invalid claims administrator.

Arch Insurance

DaisyBill lists Arch Insurance Group as an invalid.

Athens Administrators

An investigation by NBC’s California Bay Area affiliate reports that San Jose’s Human Resources Department has overturned Athens Administrators’ denial of treatment to dozens of San Jose firefighters.

State Compensation Insurance Fund

Per a representative, State Compensation Insurance Fund (SCIF) unveiled a “new program” with regard to billed Evaluation and Management codes (CPT codes 99201 – 99205 for new patients; 99211 – 99215 for returning patients). If the level of billed E/M service is not supported by the supporting documentation, the E/M code will now be denied and $0 will be sent as payment.

AIG / MedRisk Incorrect Denials

DaisyBIll providers report receiving incorrect and very confusing denials from MedRisk, a managed care provider network, for bills that were actually submitted directly to AIG.  The MedRisk denials state: “Not currently a participating MedRisk provider. Please submit bill directly to insurance carrier.”

City of LA Switches Bill Review to Medata

The City of Los Angeles recently shook up their Bill Review program, making the switch from Stratacare to Medata as of April 1, 2017.

County of Ventura Switches Bill Review to York

The County of Ventura severed its alliance with CorVel, opting instead to partner with York as of May 1, 2017. The DaisyBill compliance team reached out to York, CorVel, and the County of Ventura for details. All three entities confirmed the change. We also learned something else: York will be changing the claim numbers for all County of Ventura bills with dates of service prior to May 1, 2017.

American Airlines Switches Bill Review

Self-insured employer American Airlines no longer utilizes Genex Services Bill Review. Effective February 1, 2018, American switched to Sedgwick National Bill Review.

TPA Change: JCPenney Switches Third-Party Administrator

TPA Change: JCPenney Switches Third-Party Administrator

Macy's, Sedgwick Bill Review, and Payor ID

Self-insured employer Macy’s no longer utilizes EK Health Bill Review. Effective March 3, 2018, Macy’s switched to Sedgwick Claims Management Services National Bill Review.

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