cpclori
Networker
I am seeking ideas on how other offices are appealing WC carriers for additional payment when they reduce claims payment based on U&C
guidelines quoting Fair Health Benchmark or Dataisights criteria by geographical area.
Effective 09-24-15 the burden of proof for reasonable value of service was moved from the carrier to the provider under NH WC law 281-A:24
Prior to this change, there was no fee schedule in NH, and most claims were paid at 100% of charge, although some items were reduced for U&C.
Is anyone submitting appeals, or do most offices just accept the carrier payment and adjust the balance?
Any thoughts are appreciated
guidelines quoting Fair Health Benchmark or Dataisights criteria by geographical area.
Effective 09-24-15 the burden of proof for reasonable value of service was moved from the carrier to the provider under NH WC law 281-A:24
Prior to this change, there was no fee schedule in NH, and most claims were paid at 100% of charge, although some items were reduced for U&C.
Is anyone submitting appeals, or do most offices just accept the carrier payment and adjust the balance?
Any thoughts are appreciated