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CALIFORNIA WORKERS COMPENSATION COLLECTIONS
PUBLICATIONS, EDUCATION AND INFORMATION FOR TREATMENT AND
COLLECTIONS DISPUTES
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July 2014 Collections
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Mid July 2014
Collections Newsletter
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Issues of Causation / Contested Liability  Issues / Procedural Issues / Pleadings / General Law and Information
All States Work Comp News, Issues, Articles Daily
Medical Legal Providers and Procedures /
Medical Legal Services
Hospitals. Burn Centers, Trauma Centers  Long
Term, Outpatient / PPO
MPNs (Medical Provider Networks)
Interpreter Services and Issues / Procedures
Denied Cases / Contested Liability Issues
Outpatient Surgery Centers
Sanction Issues at WCAB
Psychiatric  Treatment / Medical Legal / Pain
Management
Medication / Compound / Physician Dispensed /
Pharmacy
Copy Services / Medical Legal
Toxicology / Urine Drug Screening
DME (Durable Medical Equipments)
Medical Testing Services
MD, PTP, Treatment - Chiropractic / Physical
Therapy / Acupuncture
General Billing Issues / Medical Necessity  Issues
January 15, 2015: Pleading: Sample: "Petition
for Non-IBR- Medical Legal" for Interpreters
January 15, 2015: Medical Legal: Case When
are service medical legal and when are they
treatment even when requested by a PTP,  when
does not do or bill for a medical legal
January 15, 2015: Pleading: Sample: "Petition for
Non-IBR- Medical Legal" for Interpreters
January 15, 2015 Medical Legal:  Lien : did not
show that its diagnostic services were "capable of  
proving or disproving a disputed medical fact."
January 15, 2015: Sanctions: Outline 65 pages

January 15, 2015: Research Paper:
WCAB: Avoiding Sanctions at The WCAB,
Simple Acts Changes Everything
Surgeries Professional Component
January 16, 2015: Research Paper:
WC Billing, E&M, RFA, Medical Legal ,
Record Review, Providers Missing the Point!
January 16, 2015: Research Paper:
WC Billing, E&M, RFA, Medical Legal ,
Record Review, Providers Missing the Point!
Lien Issues
Medical Necessity Issues
Home Health Care
Sample Pleadings / Petitions / Response Etc.,
anuary 15, 2015: Liens: 45 Page outline
regarding lien issues
October 13, 2014: Panel Decision: Home Health
Care:
The first condition  requires that home health
care services be prescribed by a physician, and
an employer may become liable for home health
care services provided 14 days prior to receipt of
a prescription. The second condition requires
that an employer's liability for home health care
services is 2 subject to either section 5307.1 or
section 5307.8."
September 22, 2014: See why providers are
trying to put physical therapists out of the
work comp business The worst offenders of
Sloppy RFAs (so bad that they have to be
purposeful)  that have 10's of thousands of IMRs
upholding UR denials are requests for physical
therapy, acupuncture and chiropractor visits, and
it is not that the treatment is not needed,
January 20, 2015, WCAB States can enforce
settlement agreements outside of lien however the
agreements in this case were not drafted properly:
January 20, 2015, WCAB States can enforce
settlement agreements outside of lien however the
agreements in this case were not drafted properly:
January 21, 2015: Panel_Denied_ Post
Termination -Employer Should have Known of
Injury before Termination
January 22, 2015: Panel:  found that defendant
had failed to  prove the existence of a valid
Medical Provider Network (MPN). ---. also failed
to provide the proper access standards of
chiropractic primary treating physicians as required
January 30, 2015: WCAB Awards an Additional
$98,383.57 Above Fee Schedule.
January 30, 2015: Panel Decision: WCJ with
WCAB Upholding an award of $98,388.57 above
the fee schedule.
Todays Posted Information
January 30, 2015: WCAB Awards an Additional
$98,383.57 Above Fee Schedule.
January 30, 2015: Panel Decision: WCJ with
WCAB Upholding an award of $98,388.57 above
the fee schedule.
Feb -2015 Collections
Newsletter
Jan -2015 Collections
Newsletter
Oct 2015 Collections
Newsletter
California Workers' Comp
West Virginia Workers'
February 04, 2015: Alabama MAXIMUM FEE
SCHEDULE FOR PHARMACEUTICS
February 04, 2015: Alaska Fees for Out-of-State Medical
Treatment and Services
February 04, 2015: Arizona: Commission to Consider
Adoption of Treatment Guideline Process
February 04, 2015: Arkansas Case Law :"..compensable
injury combines with a preexisting disease or condition or
February 04, 2015: Colorado For Hospital Inpatient
Discharges Dates of Service on and After 1/1/2015
February 04, 2015:    Connecticut WCC Official Hospital
and Ambulatory Surgical Center Fee Schedule Memorandum
February 04, 2015 :Georgia Workers’ Compensation
Medical Fee Schedule Pharmaceuticals
February 04, 2015: Iowa Case Law: The words “arising out
of” referred to the cause or source of the injury.  The words
“in the course of” refer to the time, place, and circumstances
of the injury.
February 04, 2014  Kansas The January 1, 2015 edition of
the Schedule of Medical Fees
February 04, 2014 Kentucky: Parties Impacted by the 2013
Workers’ Compensation Schedule of Fees for Physicians
February 04,2014 Louisiana Approval of Routine Evaluation
and Management Visits/Therapeutic Exercises -
Clarifications--
February 04, 2014: Main Medical Fee Schedule Annual
Update The Board has completed its annual update of the
medical fee schedule
February 04, 2014 Massachusetts Filing a Lien/Claim For
Payment of Services
February 04, 2015: Michigan:  R 418.101101 Calculation
and revision of payment ratio for Michigan hospitals.  Rule
1101. (1)
February 04, 2015: Mississippi ◾2015 DRG Relative
Weights
February   02, 2015 Alabama News: Out-of-State Medical
Providers
February 02, 2015: Arizona: What is subject to fee schedule
and what is subject to usual and customary fees
February 02, 2015: Arkansas Case Law: Issue:
barred unless filed within one year from the date of the last
payment of compensation or two years from the date of the
injury, whichever is greater
February  02, 2015: Colorado:
Industrial Claim Appeals Office
Table of Cases
February  02, 2015 Case Law: CONNECTICUT "... must
stand unless they are without evidence, contrary to law or
based on unreasonable or impermissible factual inferences.”
February  02, 2015: Delaware
Workers' Compensation Health
Care Payment Rates for Physicians
and Hospitals (the "Fee Schedule").
February 02, 2015: Florida
Workers’ Compensation
Health Care Provider
Reimbursement Manual
2015 Book on Authorization, Utilization Review With 1000 IMR Decisions to Show Why
Treatment is not Being Authorized. Not only did the formalities of the WCAB and the IBR
process change but also the detail requirements in the request for authorization and to get UR
reversal by IMRs. A missed word and a left out explanation, a lack of documents, changes if the
treatment is authorized or if reversed and certified by IMR
Also receive 1500 IBR Decisions summarized
and indexed
February 24, 2015: UR/Authroization UR
Denial Overturned: 1 Evaluation with Pain
Psychologist
February 24, 2015: Educational chart  
Authorization / Payments / Facility /
Physician Carpal tunnel release
February 24, 2015: Educational chart  
Authorization / Payments / Facility /
Physician Carpal tunnel release
00003029328 / 1799 / 99080        FS=$9.68 / $377.15 / 0        Provider
00300 QZ (6 units)        FS=$278.59 / additional awarded         Provider
00300 QZ (6 units)        FS=$139.00 / Insurance        
00300 QZ (6 units)        FS=$167.15 / for provider        Provider
00300-QZ-QS        FS=196.68        Provider
0060 QZ (9)        FS=$294.98 / for provider        Provider
0060 QZ (9)        FS=$294.98 / for provider        Provider
00630        FS=295.02        Provider
00630        FS=295.02        Provider
00630        FS=278.63        Provider
00630        FS=295.02        Provider
00630        FS=$295.02 / Additional $131.14 Awarded        Provider
00630        FS=$250.73 / for provider        Provider
00630        FS=$327.80        Provider
00630 modifier QZ (9 units)        FS=$250.73 for provider        Provider
00630 QZ        FS=$250.73        Provider
00630 QZ        FS=$295.02        Provider
00630 QZ         FS=$250.73        Provider
00630 QZ         FS=$291.16        Provider
00630 QZ         FS=$291.16        Provider
00630 QZ         FS=$250.73        Provider
00630 QZ         FS=$264.69        Provider
00630 QZ         FS=$264.69        Provider
00630 QZ         FS=$238.22 / Additional $98.392        Provider
00630 QZ         FS=$238.22 / Additional $98.392        Provider
00630 QZ         FS=$350.53 / Additional $221.23        Provider
00630 QZ         FS=$323.22        Provider
00630 QZ         FS=$294.98 / Additional $88.49        Provider
00630 QZ         FS=$140.21        Provider
00630 QZ         FS=$238.22/ Additional $98.92        Provider
00630 QZ         FS=$167.15 / Additional $27.85        Provider
00630 QZ        FS=$278.58 / for provider        Provider
00630 QZ        FS=$250.73        Provider
00630 QZ OS        FS=$250.73 / Additional amount awarded $63.91        Provider
00630 QZ OS        FS=$256.73 / Additional amount awarded $73.74        Provider
00630 QZ OS        FS=$124.69 / Additional amount awarded $125.39        Provider
00630 QZ OS        FS=$250.72 / Additional amount awarded $111.42        Provider
00750; 94760        FS=00750=$163.88 / 94760=0 / for insurance        Insurance
01610 OZ OS        FS=0        Insurance
0232T        FS=$900.00 / Initial Payment 0 / $900.00 awarded Provider        Provider
11100        FS=0 / for insurance no documentation         Insurance
11100 / 11101        FS=11100=$76.60 / 11101=$196.92 for provider        Provider
11100 59        FS=0 / services not authorized        Insurance
11101 59 / 17002        FS=11101 59 =$133.59 / 17002=$72.70 for provider        Provider
12001        FS=$61.20 / for provider        Provider
12042 / 90471        Fs=227.00        Insurance
1213-51-F7 /26756-59 / 26750-59-51        FS=Varies         Decision for Provider
14300        FS0 Code deleted  in 2010        Insurance
15740 / 17311 / 17106 / 11100 / 11101        FS=15740=$1,066.24 / 17311=$161.43  / 17106=$87.84 / 11100=$47.72 / 11101=$27.92 / for provider        Provider
17002        FS=40        Insurance
17002        FS=40        Insurance
17002        FS=$232.64 / for insurance        Insurance
17002        FS=60        Insurance
17002        FS=$74.26 / for insurance         Insurance
17002        FS=$47.31 / for insurance        Insurance
17002  / 17001        FS=40 / 22.00        Insurance
17002 (11)        FS=0 / lack of documentation / for insurance        Insurance
17002 (21 units)        FS=40.00        Provider
17002 (21 units)        FS=40.00        Provider
17002 (25)        FS=$363.50 / for Provider        Provider
17002 / 69100 / 17001         FS=42.62 / 203.65 / 40.00        Insurance
17002X19        FS=189.02 / 0 paid        Provider
17034 / 17107        FS=2nd=17304=$416.16 / 17107=$188.58 / for provider        Provider
17034 / 17999        FS=17034=$416.16 / 17999=$52.05 / for provider        Provider
17106 (17999) / 11100 / 11101        FS=17106 (17999)=$87.85 / 11100=0 / 11101=0 / for insurance        Insurance
17106 / Billed as 17999        FS=$104.09        Insurance
17106 -59        FS=$104.04        Insurance
17108        FS=$425.00 / for provider        Provider
17108 / Billed as 17999        FS=$350.00        Provider
17108 Billed as 17999        FS=$500.00        Provider
17262 /11100 / 17000 / 17001 / 17002        FS=17262=52.02 /11100 =26.01/ 17000=9.76 / 17001=49.42 / 17002=333.69        Insurance
17304        FS=416.16        Provider
17304        FS=416.16        Provider
17304        FS=$416.16        Provider
17304        FS=$691.92        Provider
17304 / 1799 /        FS=17304=$416.16 / 17999=$52.02 / for provider        Provider
17304 / 17999        FS=17304=$416.16 / 17999=$104.04 / for provider        Provider
17304 / 17999        FS=17304=$416.16 / 17999=$52.02 / for provider        Provider
17304 / 17999 59        FS=17304=$416.00 17999 56=$52.02 / for provider        Provider
17304 / 17999 59 / 11100 59 / 11101 59 /        FS=17304=$416.16 / 17999 59=$104.04 / 11100 59=$13.01 / 11101 59=$9.27 / for provider        Provider
17304 / 17999-59 / 111000-59        FS=$416.16        Provider
17304 / Billed as 17999        FS=$416.16        Provider
17304 and 17999 Modifier 59        FS=17304=$416.16 / FS=17999=$52.02 / for provider 25% PPO discount        Provider
17304; 17304 modifier 59; 17999 modifier 59; 17999 modifier 59        FS=17304=$416.16; 17304 modifier 59=$416.16; 17999 modifier 59=$52.02; 17999 modifier 59=$52.02  / for
provider        Provider
17304; 17999        FS=17304=$416.16 / 17999=$52.02 / for insurance         Insurance
17304; 17999        FS=17304=$416.16 / 17999=$52.02 / for insurance         Insurance
17304; 17999 59        FS=17304=$489.60 / 17999 59=$52.02 / for insurance        Insurance
17311; 17999 modifier 59        FS=17311=$416.16 / FS=17999.59 = $59.02 / for provider        Provider
17999         FS=$104.04        Insurance
17999         FS=$377.15        Insurance
17999        FS=$489.60        Insurance
17999        FS=$104.04        Insurance
17999        FS=$208.08 / for insurance lack of documentation         Insurance
17999        FS=$209.08        Insurance
17999        FS=$619.34 / for insurance         Insurance
17999        FS-$2,463.00        Provider
17999        FS=$17999        Insurance
17999        FS=$94.29        Insurance
17999        FS=$25.37 / for Insurance         Insurance
17999        FS=0 no report supplied for review        Insurance
17999 (1)        FS=17999 = $377.15 / for  insurance         Insurance
17999 (59) / 17000 (59) / 17001 (59) / 17002 (59) / 111000 959) / 11101 (59)        17999 (59)=$104.04 / 17000 (59)=$9.76 / 17001 (59)=$49.42 / 17002 (59)=$284.26 / 111000 959)
$13.01/ 11101 (59=$185.34  / for provider        Provider
17999 / 17999 / 17999/ 17999/ 17999        FS=17999=$297.50 / 17999==$297.50/ 17999=$297.50/ 17999=$297.50/ 17999=$297.50 / for provider        Provider
17999 / 99080 / 99085 / 99086        FS=17999=$130.82 / 99080=0 / 99085=0 / 99086=0 / for insurance        Insurance
17999 59        FS=$220.32 / for insurance        Insurance
17999; 99080; and 99085        FS=17999=$1,020.36; 99080=0; 99085=0 / for insurance        Insurance
17999; 99080; J3301        FS=17999=$377.15 / 99080=$17.14 / J3301=0 / for provider        Provider
17999; J3301; 11901; 99080        FS=17999=$377.15 / 00003-0494-20=$15.26 / 99080=0 / for provider        Provider
17999-59        FS=$104.40 /  additional $52.02        Provider
18860072210        FS=$1,559.64 / for provider        Provider
20550 Modifier 51        FS=$22.95 / for Provider        Provider
20680        FS=2,171.85        Provider
20680 / 20680 / 20680 / 29125        FS=0 bundled in procedures        Insurance
22110 /22110 59 / 22116 / 22116 59 / 76001 / 64830         FS=22100=0 /22100 59=0 / 22116=0 / 22116 59=0 / 76001=$228.00 / 64830=$1,024.72        Provider
22325 / 22612        FS=0        Insurance
22554 – varies        FS=Varies        Provider
22554 varies        FS=Varies 0        Insurance
22554 varies         FS=0 / for 11 billed codes        Insurance
22554 varies         FS=0 / for 11 billed codes        Insurance
22554; 22851; 22851 59 – ASC Services        FS=22554; 22851; 22851 59 – ASC Services=$4,825.12 / for insurance        Insurance
22612 / 22842 /22851 / 64550 / 72100 / 72148        FS=0        Insurance
22612 / 63047 / 63048        FS=0        Insurance
22612 // 22842 / 22851 / 64550 / 63030 / 22842 / 64550 / 72100 / 22630 / 22851        FS= Varies         Insurance
22612 varies        FS=Varies 0        Insurance
22830 / 22855 / 63090 / 63091 / 63047        22830 =$897.09/ 22855=$446.95 / 63090=999.29 / 63091=$669.98 / 63047=1,998.56        Provider
22830 / 63090 / 63091 / 22558 / 22845 / 22851        FS=Varies        Provider
22830; 22855; 63090; 63091; 63047        FS=63047=$1999.00 / FS=22830=$448.54 /FS=22830=$448.54 /FS=22855=$2,234.76 /FS=63090=$1,999.00 / FS=$670.00 / for provider        
Provider
22830-62-51 / 22852 62-51 / 63047- 62-22 / 63047-62-22        FS=1958.59 /1313.16 / 0 / 0        Provider
22842 /20936/64722        FS=0 / Included in other services         Insurance
22845        FS=1,065.00 / 1,065.00 awarded        Provider
22851        FS=784.89 / 784.89 awarded         Provider
23020 / 20610 / 29823 / 23700         FS=0        Insurance
23430        FS=4,258.07        Provider
23700        FS=0        Insurance
24102; 25290; 24341         FS=24102=$2,568.91 / 25290=0 /24341=0 / for insurance         Insurance
24314        FS=Claims adjuster reimbursed $5,587.81 for 64708; 25290; 24102; 26442 therefore no additional payments for $24341 / for Insurance        Insurance
24314; 25290        FS=24341=$13,398.83 / FS=25290=$2,568.92        Provider
24341 / 64718        FS=$9,878.20 / for insurance        Insurance
24341 / 64718        FS=$10,910.47 / awarded an additional of $7,669.41        Provider
24342        FS=5,821.52        Provider
24357-LT        FS=2568.91        Provider
25000 Modifier 51        FS=$232.00 / for provider         Provider
25020 / 64721        FS=0 / No indication separate procedure         Insurance
25020 / 64721-51        FS=$2,301.68 / FS=0        Insurance
25020 / 64727        FS=0 / Documentation did not support procedures billed         Insurance
25118 / 25118-5        FS=$2,137.35 / $1,068.68        Insurance
25150        FS=3,111.34 / 25150 not suspect when performed with CPT code 64718        
25320-59 / 64772        FS=603.21 / FS=221.85 / For Insurance        Insurance
25609 / 25350 / 29845 / 29846 / 20690        FS=Varies         Provider
26055 / 26055        FS=1,096.60 / 168.93  o paid awardee fee schedule         Provider
26145        FS=2,943.34 / awarded 2,943.34        Provider
26145        FS=$5,643.72  / Additional $3,762.51 awarded        Provider
26145        FS=$5,366.43        Provider
26145 / 64721        FS=3,846.90 / 322.59        Provider
26145 x 9 units  no payments        FS=$5,940.68 / for provider full amount of fee schedule        Provider
26145; 26055        FS=26145=0 / FS=26055=$1,096.60 / for insurance        Insurance
26370; 26373; 26373; 20103        FS=ASC Facility Services = $3,822.59 / for provider        Provider
26686 FS        PPO  issue SCIF  / Blue Cross additional $7,000.00 awarded         Provider
27399        FS=2,286.17        Insurance
274 (L1990 & L2820)         FS=576.46        Provider
274 /  278        FS=no for implants Fs=DME =782.00        Provider
274 Revenue Code        FS=$314.00 / payment of $314.00 to provider / for provider        Provider
27422; 29870; 29881; 29875        FS=27442(29877)=$1,953.38 / 29881=$976.69  29875=0 / 29870=0 / for insurance         Provider
27570 / 29870        FS=0 included in surgery / for insurance        Insurance
27570 / 29870 / 20610        FS=0 included in surgery / for insurance        Insurance
27625; 29898; 20605        FS=27625=$2,133.55 / 29898=$976.69 / 20605=0 / for insurance        Insurance
27685        FS=$141.72 / for provider        Provider
27685 Modifier 51        FS=$289.98 / for Insurance        Insurance
27698 / 28086 / 64445 / 64447        FS=3,016.00 /1,035.50 / 369.85 / 190.70        Provider
29580        FS=0 no  modifier to show separate payable         Insurance
29807 / 29823 / 29826 / A6531         FS=$5,916.72        Insurance
29808 / 29823-59 / 29999        FS=0 /1794.72 / 0        Provider
29819 / 29820        FS=0 / no documentation / for insurance         Insurance
29819-59 / 29820-59        FS=0 / documentation  did not support         Insurance
29820-51 / 29823        FS=1781.31 / 3,562.93        Provider
29823        FS=5,287.00        Provider
29823        FS=3,589.45        Insurance
29823        FS=$1,482.51        Insurance
29823        FS=$1482.57 / Awarded $1482.57         Provider
29823        FS=$1,408.44 = paid prior to IBR determination insurance to pay IBR fee         Provider
29823        FS=5,340.40        Provider
29823        FS=4,806.36        Provider
29823        FS=498.78        Provider
29823        FS=$490.56 / for insurance        Insurance
29823 / 29807 / 29826 / 29823 / 29825 / 29827 / 29805        FS=Varies        Provider
29823 / 29821        FS=$3,595.15 / 0        Insurance
29823 / 29823-51 / 29829-59 / 20610        FS=0/0/ 1956.54/0        Insurance
29823 /29824        FS=6,589.61 Additonal Awarded $3,710.26        Provider
29823; 29826; 29827; 23120; 20690; 29805;        FS=29823-$3,595.25; 29826=$978.27; 29827=$1,797.63; 23120=0; 20690=0; 29805=0;        Insurance
29824        FS=1,800.02        Insurance
29824        FS=1,800.02        Insurance
29824        FS=1.800.02        Insurance
29824        FS=1956.54        Insurance
29824        FS=901.00        Insurance
29824        FS=1956.54        Insurance
29824        FS=$1,081.73 / for provider        Provider
29824 / 29826        FS =1,395.00         Provider
29824 /C1713        FS=1936.21        Provider
29824-29826        FS=1,453.13 / 1,453.13        Provider
29824-RT        FS=900.02        Insurance
29825 (51)        FS=0 / for insurance        Insurance
29826        FS=3,039.19        Provider
29826        FS=0        Insurance
29826-51        FS=741.29 / Additional 741.29 awarded to provider        Provider
29827        FS=4,298.25 / Additional $2,510.65 awarded         Provider
29827 / 29824 / 29826        FS=5,340.40 / 1453.13 / 1453.13        Provider
29827 / 29826 / 29822 / L8699        FS=$4,321.17 / $1,175.80 / 0 / 0        Insurance
29827 /29826        FS=$6,00.37        Provider
29846 / 64721        FS=$3,525.10 / for provider        Provider
29870 / 27570 / 20610         FS=0 / reports and documentation did not justify billing         Insurance
29870 / 29881 59 / 29877 59 / 29877 59 / 20610        FS= Varies        Provider
29870 etc.        FS=varies         Insurance
29876 / 29870 / 27570         FS=29876=$861.92 / 29870=0 / 27570=0 / for provider         Provider
29879-59        FS=0 / billed wrong code        Insurance
29880 / 29877 / 29874 / 29875 / 20610        FS=29880=$1,569.78  / 29877 =$113.37/ 29874 =0/ 29875=$107.56 / 20610=0        Provider
29880 /82962 / J1170 / J2250 / J2405        FS=2,332.68 / additional 751.32 awarded         Provider
29880;29870;29871;29875        FS=29880=0; 29870=$1,953.38; 29871=0; 29875=$976.69 / for insurance         Insurance
29880-51 / 29888 / 99070 / 29880-59 / 29876-59        FS=5,423.17        Provider
29881        FS=3,576.01        Provider
29881 / 29875        FS=29875=$2,673.75 / 29875=0 / for Insurance        Insurance
29881 / 29875 (59)        FS=29881=$2,673.75 / 29875 (59) =0 / for insurance        Insurance
29881 / 29876        FS=29881=$2,673.75 / FS=29876=$1,336.88 / for provider        Provider
29881-LT        FS=2351        Provider
29888        FS=$2,296.353 / for insurance        Insurance
29899-RT-59 / 20680 RT-50 / 27870-RT        FS=6,528.70 / 1,175.79 / 924.92        Provider
29914        FS=2,456.58         Insurance
36478        FS=2,139.09 / additional awarded $1,560.77        Provider
37720 / 76942 / 93971        FS=$566.87 /$62.51 / $57.32        Provider
37720 / 76942 / 93971        FS=37720=$566.387 / 76942=$62.51 / 93971=$57.37 / for provider        Provider
37785 / 76942 / 93971        FS=37785=$333.59 / 76942=$53.13 / 93971=$48.72        Insurance
37785 / billed at 37799        FS=$71.23        Provider
37799        FS=$614.68        Provider
37799 (37720; 76949 26 and 93971 26)        FS=37799=$583.76 / 99080=0 / 99086=0 / for provider        Provider
37799 (37785 / 76942-26)        FS=$481.84        Insurance
37799 (37785 / 76942-26)        FS=$481.84        Insurance
37799 (37785 / 76942-26)        FS=$481.84        Insurance
37799 (37785 / 76942-26)        FS=$466.39        Insurance
37799 (37785, 76942 26 and 93971        FS=$435.50 / for insurance        Insurance
37799 and  99080        FS=37799=$583.69 / FS=99080=9.94        Insurance
38779056101 / 38779175603         FS=$442.24 / no payments made        Provider
38779056104        FS=$15.66 / for provider        Provider
38779056104 / 38779175603        FS=$11.38 / $451.68        Insurance
38779056104 / 38779175603        FS=$471.29 for provider        Provider
38779056104 / 38779175603        FS=147.00        Insurance
38779056104 /38779175603        FS=$442.23 / for provider        Provider
38779073105 / 38779056104 / 38779196104        FS=0 / no invoice        Insurance
45861000405 NDC        Services not authorized FS=0 / for insurance        Insurance
49452003202 / 38779052409  / 62991142202        FS=0:Determination stated that provider stated “Pharmacy Invoicing pricing will not be provided” no fee schedule determination:
decision  / for insurance        Insurance
49452003202 / 38779052409 /  / 62991142202        Insurance paid $476.71 / dispute was $4,86.69 / IBR Determination stated that provider stated “Pharmacy Invoicing pricing will not be
provided” no fee schedule determination: decision  for insurance        Insurance
49452003202 / 38779052409 /  / 62991142202        FS=0:Determination stated that provider stated “Pharmacy Invoicing pricing will not be provided” no fee schedule determination:
decision  / for insurance        Insurance
49452003202 / 38779052409 / 62991142202 / Compound         FS=0 no invoices supplied          Insurance
49452003202 / 38779052409 / 62991142202 / Compound         FS=0 no invoices supplied          Insurance
49452003202 / 38779052409 / 62991142202 / Compound         FS=0 no invoices supplied          Insurance
49452003202 / 62991142202 / 387790540        FS=0        Insurance
53746019405 / several more         FS= Varies         Provider
58468009001        FS=$273.73 / for insurance        Insurance
58468-0090-01        FS=$273.73 / for insurance        Insurance
58468-0090-01        FS=$273.73 / for insurance        Insurance
58468009003 (NDC) 12 units        FS=$1,983.16 for provider        Provider
62311        FS=119.99        Provider
62311        FS=113.99        Insurance
62311 / 00630 / 76499        FS=119.00 / 0 / 0        Provider
62311 / 76499 / 72100        FS=119.99        Insurance
62311/00630/76499/72100/62311/76499/72148/72100/99218        FS=0 for all        Insurance
62362        FS-23,117.47 Additional  $14,774.47 awarded to provider         Provide
62367 / 99081 / 99214-25 / 99401-59        FW=varies        Provider
62991140305        FS=$20.86 / for provider        Provider
62991140305 / 38779175603 / 63370004035 / 38779038805        FS=135.00        Provider
62991140305 / 38779175603 / 63370004035 / 38779038805        FS=150..00        Provider
62991140307        FS=22.81 / for provider        Provider Provider
62991140307        FS=$20.86        Insurance
62991140706        FS=$23,000.00        Insurance
62991140706 / 38779056104        FS=$78.95 / for insurance        Insurance
62991140706 / 38779056104 / 3779196806 / 18860072010 / 6337004035         FS=$95.00 /  $10.88 / $260.00 / $593.65 / $5.54/        Provider
62991140706 / 38779196806        FS=$995.49        Provider
62991140706 / 3877919806 / 18860072010 / 63370004035        FS=$390.00 /FS=$643.80        Provider
62991140706 / 38799056104        FS=Insurance paid $18,260.00  and fee schedule is $179.67 / for insurance        Insurance
62991140706 /38779196806        FS=$933.78 / for provider        Provider
6299114305        FS=$27.98 / for provider        Provider
6299114307        FS=$13.00        Insurance
63047 / 63048 / 63048 59        FS=63047=$1,650.31 /63048=$1,650.31 / 63048 59= $1,650.31 / for provider        Provider
63047-59-51        FS=859.44 / additional 859.44        Provider
63090 / 22558 -62 / 22851 / 22851- 59 / 22845 / 72100 x 45 / 72148-22        FS=Varies paid         Insurance
63090/25558/22851/22845/ 72100        FS=0 for all         Insurance
63091 62        FS=63091=$1,607.96 / for the provider         Provider
63368         FS=$43.61        Provider
63650 / 63650 / 63685 / 63685 / 63661         FS=$4,034.80 / $4,034.80 / $13,716.43 / $13,716.43        Provider
63650 /63650-59 /63650-59        FS=3,975.18 for each one provider awarded $1,550.32 for each one billed         Provider
63650 -59        FS=$1,104.66 / for insurance        Insurance
63650-59        FS=4,086.76 / Additional 2,043.83 awarded        Provider
63650-59        FS=4,086.36        Provider
63650-59        FS=$4076.64  /4,076.64 awarded to provider        Provider
63660 / 63660 59        FS=63600=$766.60 / 63600 59=$383.30 / for insurance        Insurance
636600 58 /63660        FS=1,075.59 / 537.80        Provider
63685        FS=$13,693.32        Provider
63685 / 63650        FS=22,112.88 / 5,934.32        Provider
63685 / 76496 TC        FS=63685=$13,679.51 / 76496=$95.29        Provider
63688        FS=2893.53        Provider
63688 /63661 / 63661-59        FS=1,980.12 /385.00 / 385.00  amounts awarded to provider         Provider
64483        FS=262.10        
64483        FS=0        Insurance
64483        FS=0        Insurance
64483        FS=Awarded  no initial payments        Provider
64483        FS=$1,824.45  / additional $717.06 awarded         Provider
64483 / 72100 / 76000 / 94760        FS=64483=$945.27 / FS=72100=$27.90 / 76000=0 / 94760=        Insurance
64483 LT 1 unit and 64484 LT 1 unit         Fs=64483=$525.50 / 64484=$135.50 // for provider        Provider
64484        FS=191.76        Insurance
64484        FS=$129.26        Provider
64484 / 64483        FS=64484=$203.23 / for provider        Provider
64484 / 99214 / 64483-59 / 64484 / 01936        FS=Varies        Provider
64484 / 99214 / 64483-59 / 64484 /01936  (DOS 2014)        Varies         Provider
64484 rt / 64484 lt        FS=64484 RT=$57.59 / 64484=$115.18 / for insurance        Provider
64484-LT        FS=180.98        Insurance
64484-RT        FS=162.45        Insurance
64490        FS=262.75 / 262.75 awarded        Provider
64490 / 261.68        FS=261.68 / 84.46        Provider
64493 / 64494        FS=630.04 / 101.68        Provider
64494-50        FS=188.50        Insurance
64555        FS=32.51 x3        Provider
64555        FS=215.01        Provider
64555 59        FS=8,217.02 / for provider        Provider
64636        FS=0 / for insurance        Insurance
64640-59        FS=50.87        Provider
64719 51        FS=$256.40 / for provider applied PPO discount        Provider
64721        FS=0 / No indication separate procedure         Insurance
64721        FS=$0        Insurance
64721 / 26145        FS= $1,497.53 / FS= $5,940.68        Provider
64721 / 26145         FS=Varies        Provider
64721-51        FS=0        Insurance
64722 (59)        FS=0 – service including in other services no fee schedule determined        Insurance
64830 20 / 72100 / 72148 26        FS=64830 20 / 72148=0/ 72148 26=0 /         Provider
64999        FS=3,226.88        Provider
64999 (63047)        FS=$2,558.16 / for Provider        Provider
70450        FS=0        Insurance
70553        FS=784.00        Provider
72070 / 72110        FS=57.23 / 83.86 awarded         Provider
72100 / 69990 / 63042 / 63042 / 62311 / 63709        FS-Varies         Provider
72100 / 69990 / 63042 / 63042 / 62311 / 63709        FS-Varies         Provider
72100 / 69990 / 63042 / 63042 / 62311 / 63709        FS-Varies         Provider
72141        FS=516.80        Provider
72146        FS=512.00        Provider
72148         FS=512.00        Provider
72148        FS=512.00        Provider
73221        FS=521.91        Provider
73721        FS=532.00        Provider
76942 / 64445 /         FS=0 / did not put proper modifier         Insurance
76942 / Billed 99135        FS=0        Insurance
76942 / Billed 99135        FS=0        Insurance
8000        FS=119.94        Provider
8000 codes        FS=G0431-119.95        Insurance
8000 codes        FS=G0431-119.95        Insurance                
8000 codes        FS=107.95        Insurance
80000 codes no bundles        FS=$371.93 – for provider $371.93         Provider
80102 and 82486        FS=G0431=$119.94 / 80102=0 / for provider         Provider
80154        FS=0        Insurance
80154        FS=0        Insurance
80154 / 80299 etc.        FS=G0431=107.95 / 83986= 5.31 / 81002=3.80        Provider
80154 / 80299 etc.        FS=G0431=113.17 / 83986= 5.31 /         Provider
80299-59 /83840 /83925-59 /83986 /83992 /81002 /80152        FS=5.31 / 3.80        Provider
82055 / 80299 59 / 80299 59 / 83925 59 / 83986 / 83992 / 81002 / and 80152        FS=G0431=$107.95 / 82055=$16.04 / $4.43 /  81002=$3.17        Insurance
82055 / 82145 / 80154 / 80299-59 /82520 / 80299-59 / 83840 / 83925-59 9x2 0 / 83986 / 83992 / 81002 /80152 /        FS=G0431=$107.95 / 3.17 / 4.43 / 16.04         Provider
82055; 82145; 82205; 80299 (2); 82520; 83840; 83925 (3); 83986; 83986; 83992; 81002 and 80152        FS=G0431=$107.95 /81002; $3.80 /83986=$5.31 / for provider        Provider
82145 / 80154 / 82520 / 83925 / 83925-59 / 82145        G0431=118.00        Provider
82145 / 80154 / 82520 / 83925 / 83925-59 / 82145        FS=0 for all / no authorization attached to IBR request        Decision for Insurance
82145 / 82145-59 / 82520 / 83840 / 83992 / 83925 / 82055 / 82205 / 82570        FS=101.18        Provider
82145 / 82145-59 / 82520 / 83840 / 83992 / 83925 / 82055 / 82205 / 82570        FS=101.18        Provider
82145 / 82145-59 / 82520 / 83840 / 83992 / 83925 / 82055 / 82205 / 82570        FS=113.09        Provider
82145 / 82145-59 / 82520 / 83840 / 83992 / 83925 / 82055 / 82205 / 82570        FS=101.18        Provider
82145 / 82145-59 / 82520 / 83840 / 83992 / 83925 / 82055 / 82205 / 82570        FS=113.99        Insurance
82145 / 82145-59 / 82520 / 83840 / 83992 / 83925 / 82055 / 82205 / 82570        FS=113.99        Insurance
82145 / 82205 / 80154 / 82520 / 83840 / 83992 / 83925 / 83925-59 / 82145-59 / 82055 /82570        FS=Bundles under G0431=119..04 and only 82055=$17.69 no bundled        Decision
for Insurance
82145 / 82205 / 80154 / 82520 / 83840 / etc.        FS=Bundles under G0431=119..04 and only 82055=$17.69 no bundled        Insurance
82145 / 82205 / 80154 / 82520 / 83840 / etc.        FS=Bundles under G0431=119..04 and only 82055=$17.69 no bundled        Insurance
82145 / 82205 / 80154 / 82520 / 83840 / etc.        FS=Bundles under G0431=119..04 and only 82055=$17.69 no bundled        Insurance
82145 / 82205 / 80154 / 82520 / 83840 / etc.        FS=Bundles under G0431=119..04 and only 82055=$17.69 no bundled        Insurance
82145 / 82205 / 80154 / 82520 / 83840 / etc.        FS=Bundles under G0431=119..04 and only 82055=$17.69 no bundled        Insurance
82145 / 82205 / 80154 / 82520 / 83992 / 83925 / 82145 / 82055 / 82570        FS=G0431=$119.94 / 82055=$17.85 / 82570=$8.53 / for provider        Provider
82145 / 82205 / 82520 / 83992 / 83925 / 83925 / 83925-59 / 82145-59 / 82055 / 82570        FS- G0431=101.95 and 82055/$15.15 / rest bundled        Provider
82145 / 82205 / 82520 / 83992 / 83925 / 83925 / 83925-59 / 82145-59 / 82055 / 82570        FS- G0431=139.95 and 82055/$16.93 / rest bundled        Provider
82145 / 82205 / 82520 / 83992 / 83925 / 83925 / 83925-59 / 82145-59 / 82055 / 82570        FS- G0431=107.95 and 82055/$5.31/ 81002 3.80 / rest bundled        Provider
82145 / 82205 / 82520 / 83992 / 83925 / 83925 / 83925-59 / 82145-59 / 82055 / 82570        FS- G0431=107.95 and 82055/$5.31/  83986 5.31/ 81002 3.80 / rest bundled        Provider
82145 / 82205 / 82520 / 83992 / 83925 / 83925 / 83925-59 / 82145-59 / 82055 / 82570        FS- G0431=107.95 and 82055/$5.31/ 81002 3.80 / rest bundled        Provider
82145 / 82205 / 82520 / 83992 / 83925 / 83925 / 83925-59 / 82145-59 / 82055 / 82570        FS- G0431=119.95 and 82055/$5.31/ 81002 3.80 / rest bundled        Provider
82145 / 82205 / 82520 / 83992 / 83925 / 83925 / 83925-59 / 82145-59 / 82055 / 82570        FS- G0431=107.95 and 82055/$5.31/  83986 5.31/ 81002 3.80 / rest bundled        Provider
82145 / 82205 / 82520 / 83992 / 83925 / 83925 / 83925-59 / 82145-59 / 82055 / 82570        FS- G0431=107.95 and 82055/$5.31/  83986 5.31/ 81002 3.80 / rest bundled        Provider
82145 / 82205 / 82520 / 83992 / 83925 / 83925 / 83925-59 / 82145-59 / 82055 / 82570        FS- G0431=107.95 and 82055/$5.31/  83986 5.31/ 81002 3.80 / rest bundled        Provider
82145 / 82205 / 82520 / 83992 / 83925 / 83925 / 83925-59 / 82145-59 / 82055 / 82570        FS- G0431=107.95 and 82055/$5.31/  83986 5.31/ 81002 3.80 / rest bundled        Provider
82145 / 82205 / 82520 / 83992 / 83925 / 83925 / 83925-59 / 82145-59 / 82055 / 82570        FS- G0431=107.95 and 82055/$5.31/  83986 5.31/ 81002 3.80 / rest bundled        Provider
82145 / 82205 / 82520 / 83992 / 83925 / 83925 / 83925-59 / 82145-59 / 82055 / 82570        FS- G0431=107.95 and 82055/$5.31/  83986 5.31/ 81002 3.80 / rest bundled        Provider
82145 /82205 / 82520 / 83840 / 83992 / 83925 / 83925-59 / 82145-59 / 82055 /  (2014)        FS=G0431=113.09 / 82055=16.81        Provider
82145 /82205 / 82520 / 83840 / 83992 / 83925 / 83925-59 / 82145-59 / 82055 /  (2014)        FS=G0431=119.95 / 82055=16.81        Provider
82145(2); 82205; 80154; 82520; 83840; 83840; 83992; 83925 (2)        FS=Bundled under G0431=$107.94 / for  provider        Provider
82145/ 82205/ 82520 / 83840 / 83992 / 83925 / 82145 / 82055 / 82570        FS=G0431=$113.94 82570=$8.10 / 82055=$16.93 / for provider                Provider
82145; 82205; 80154; 82520; 83840; 83840; 83992; 83925; 83925 mod 59; 8214559; 82055 and 82570        Fs=G0431=$119.94 / 82055 = $17.85 / 82570= $8.53        Insurance
82145; 82205; 80154; 82520; 83840; 83840; 83992; 83925; 83925 mod 59; 8214559; 82055 and 82570        Fs=G0431=$119.94 / 82055 = $17.85 / 82570= $8.53        Insurance
82145; 82205; 80154; 82520; 83840; 83840; 83992; 83925; 83925 mod 59; 8214559; 82055 and 82570        Fs=G0431=$119.94 / 82055 = $17.85 / 82570= $8.53        Insurance
82145; 82205; 80154; 82520; 83840; 83840; 83992; 83925; 83925 mod 59; 8214559; 82055 and 82570        Fs=G0431=$119.94 / 82055 = $17.85 / 82570= $8.53        Provider
82145; 82205; 80154; 82520; 83840; 83840; 83992; 83925; 83925 mod 59; 8214559; 82055 and 82570        Fs=G0431=$119.94 / 82055 = $17.85 / 82570= $8.53        Provider
82145; 82205; 80154; 82520; 83840; 83840; 83992; 83925; 83925 mod 59; 8214559; 82055 and 82570        Fs=G0431=$119.94 / 82055 = $17.85 / 82570= $8.53        Provider
82145; 82205; 80154; 82520; 83840; 83840; 83992; 83925; 83925 mod 59; 8214559; 82055 and 82570        Fs=G0431=$119.94 / 82055 = $17.85 / 82570= $8.53        Provider
82145; 82205; 80154; 82520; 83840; 83840; 83992; 83925; 83925 mod 59; 8214559; 82055 and 82570        Fs=G0431=$119.94 / 82055 = $17.85 / 82570= $8.53        Provider
82145; 82205; 80154; 82520; 83840; 83840; 83992; 83925; 83925 mod 59; 8214559; 82055 and 82570        Fs=G0431=$119.94 / 82055 = $17.85 / 82570= $8.53        Provider
82145; 82205; 80154; 82520; 83840; 83840; 83992; 83925; 83925 mod 59; 8214559; 82055 and 82570        Fs=G0431=$119.94 / 82055 = $17.85 / 82570= $8.53        Provider
82145; 82205; 80154; 83480; 83992; 83925 modifier 59; 82542 and 82145 modifier 59        FS=Bundled under G043= $107.95  / for provider        Provider
82205 several 8000 codes        FS=127.73        Insurance
82415; 82205; 80154; 82520; 83840; 83992; 83925; 82145        FS=Bundled under G0431=$113.94 / for  provider        Provider
82415; 82205; 80154; 82520; 83840; 83992; 83925; 82145        FS=Bundled under G0431=$113.94 / for  provider        Provider
82415; 82205; 80154; 82520; 83840; 83992; 83925; 82145        FS=G0431=$113.94 / 82055=$16.93 / 82570=$8.10        Insurance
82486        FS=119.94        Insurance
82486        FS=119.94        Insurance
82486        FS=Bundled under G0431=$119.94 for insurance         Provider
82486        FS=Bundled under G0431=$119.94 for insurance         Insurance
82486        FS=Bundled under G0431=$119.94 for insurance         Insurance
82486        FS=113.95        Insurance
82486        FS=113.95        Insurance
82486        FS=113.95        Insurance
82486        FS=113.95        Insurance
82486        FS=113.95        Insurance
82486        FS=113.95        Insurance
82486        FS=Bundled under G0431=$119.94 / for insurance        Insurance
82486        FS=113.95        Insurance
82486        FS=Bundled under G0431=$119.94 / for insurance        Insurance
82486        FS=Bundled under G0431=$119.94 for insurance         Insurance
82486        FS=Bundled under G0431=$119.94 for insurance         Insurance
82486        FS=119.94 under G0431        Insurance
82486        FS=Bundled under G0431=$119.94 / for insurance        Insurance
82486        FS=Bundled under G0431=$119.94 for insurance         Insurance
82486        FS=$119.94 / for insurance        Insurance
82486        FS=$119.94 / for insurance        Provider
82486        FS=G0431 bundled $119.94        Insurance
82486        FS=bundled under G0431=$119.94 / for insurance        Insurance
82486        FS=bundled under G0431=$119.94 / for provider        Provider
82486        FS=G0431 bundled $119.94        Insurance
82486         FS=Bundled under G0431=$119.94 / for insurance        Insurance
82486         FS=Bundled under G0431=$119.94 / for insurance        Insurance
82486        FS=Bundled under G0431=$119.94 for insurance         Insurance
82486        FS=Bundled under G0431=$119.94 for insurance         Insurance
82486 (40 units)        FS=Bundled under G0431=$119.94 / for insurance        Insurance
82486 / to G0431        FS=119.95        Insurance
82486 3 cases        FS=119.94 under G0431        Insurance
82486 3 cases        FS=119.94 under G0431        Insurance
82486 3 cases        FS=119.94 under G0431        Insurance
82486 Billed changed  G0431        FS=119.94        Insurance
82486 Billed changed  G0431        FS=119.94        Insurance
82486 changed to G0431        FS=119.95        Provider
82486 changed to G0431        FS=119.95        Provider
82486 changed to G0431        FS=119.95        Insurance  
88305        FS=1050.00 / Additional  - 945.00 provider        Provider
88305        FS=$315.00 / for provider        Provider
88305        FS=$315.00 / for provider        Provider
88305        FS=$535.50  - additional $433.55 awarded         Provider
88305        FS=$267.75        Insurance
88305        FS=$446.25        Provider
88305 (15)        FS=1575.00        Provider
90780 / 90799 / 96376 / 25260 / 26350 / 99289 / 90781        FS=Not Bundled Varies        Provider
90833        FS=74.27        Provider
90837        FS=Varies- carrier paid 0 provider awarded fee schedule  $934.00        Provider
90862 / 99081        FS=99081=0 / 90862=$47.91 / 99081=0 / 90862=$47.91 / 99081=0 / 99081=0 / for provider         Provider
90862 / billed 90841        FS=$47.91        Provider
92215        FS=$129.41 / for Insurance        Insurance
92823        FS=0 / no modifier         Insurance
92937        FS=8,409.88        Provider
93306        FS=0 / no modifier        Insurance
93320        FS=$157.16        Provider
93320        FS=$157.16 / for insurance        Insurance
93320 / 5        FS=0 /For insurance        Insurance
93320 / 5        FS=0 /For insurance        Insurance
93320 / 93325         FS=157.16 / FS=110.08        Provider
93320 / 93325         FS=157.16 / 110.08        Provider
93320 / 93325         FS=157.16 / 110.08        Insurance
93320 / 93325        FS=157.00 / 110.00        Insurance
93320 / 93325        FS=157.16 / 110.08        Provider
93320 / 93325        FS=157.16 / 110.08 / adjuster paid 0        Provider
93320 / 93325        FS=93320=$157.16 / FS=93325=$110.08 / for         Provider
93320 / 93325        FS=157.16 / 110.00        Provider
93320 / 93325        FS=93320=$157.16 / FS=93325=$110.08 / for provider         Provider
93320 / 93325        FS=157.16 / 110.08 / no payment by insurance        Provider
93320 / 93325        FS=93320=$157.16 / 93325=$110.08 / for provider        Provider
93320 / 93325        FS=93320=$157.16 / FS=93325=$110.08 / for provider        Provider
93320 / 93325         FS=933320=$157.16 / 93325=$110.08        Provider
93320 / 93325        FS=$157.16 / $110.08        Provider
93320 / 93325 / billed = 93307        FS=$157.16 / $110.08        Provider
93320 /93325        FS=157.16 /110.08        Insurance
93320 and 93325          FS=93307 = $247.72 /93320=$157.16 /93325= $110.09 / For Insurance        Insurance
93320; 93325        FS=93320=$157.16 / 93325=$110.08 for provider        Provider
93320; 93325        FS=93320=$157.16 / 93325=$110.08 for provider        Provider
93880        FS=0        Insurance
95831        FS=0        Insurance
95831        FS=$34.40        Provider
95832        FS=Varies for provider        Provider
95851        FS=0        Insurance
95904        FS=564.01 /O paid award 564.01        Insurance
95904        FS=$806.30 / for provider        Provider
95904        FS=$806.30 / additional $322.52         Provider
95904        FS=$967.56        Providers
95904  /  95904        FS=$806.03 / FS=$322.52        Provider
95904 (52)        FS=$806.30 / for provider        Provider
95904 / 95903 / 95861        FS=752.20 / 387.00 / 95861        Provider
95904 /95904 / 99080 / 99358        Additional awarded for studies =$1,168.72        Provider
95904-59        FS=0        Insurance
95913 / 95886        FS=0 / lack of documentation          Insurance
96100        FS=899.19        Provider
96100        FS=199.82        Provider
96100        FS=$299.73 ML        Insurance
96100 / 96115        FS=699.37 / 266.42        Insurance
96100 x 4        FS=0        Insurance
96100 x 4        FS=699.37        Provider
96101        FS=0 wrong modifier attached         Insurance  
96101        FS=0        Insurance
96101        FS=0        Insurance
96101-59 /99215 / 99354        FS=634.62 /0 / 0        Provider
96360 and 99284        FS=96360=$309.37 / FS=99284=$93.42 / for provider        Provider
96530        FS=$47.05        Insurance
96530 / Billed 99214 / 96530        FS=$47.05        Provider
96530 modifier 59        FS=$47.05 for insurance        Insurance
96920        FS=184.44        Provider
96920        FS=69.44        Provider
96920        FS=77.16        Insurance
96920        FS=Awarded  0 paid initially         Provider
96920 x 2        FS=0        Insurance
97002-59        FS=47.14        Provider
97018-59        FS=0        Insurance
97113        FS=0        Insurance
97113-59         FS=0        Insurance
97113-59         FS=0        Insurance
97113-59         FS=0        Insurance
97113-59         FS=0        Insurance
97113-59        FS=0 / provider did not put start and end times         Insurance
97113-59  x4        FS=0        Insurance
97250 / 97014 / 97026 / 98943        FS=33.89 / 33.21 / 9.23 / 4.61        Provider
97530        FS=70.38 awarded        Provider
97530-59 / 97750-59        FS=70.38        Provider
97530-59 x4        FS=0 / Provider failed to show or clarify that sessions  were performed separately, simultaneously or sequentially         0 awarded decision for insurance
97799        FS=5,771.25        Insurance
97799        FS=6,198.75        Insurance
97799        FS=5,771.25        Provider
97799        FS=$5,700.00        Provider
97799        FS=$3,807.00        Provider
97799         FS=$5,700.00        Provider
97799        FS=85% of billed charges based on PPO contract of $5,100.00 / for provider        Provider
97799        FS=85% of billed charges based on PPO contract of $2,375.00 / for provider        Provider
97799        FS=$5,700.00        Provider
97799        FS=$5,700.00        Provider
97799        FS=$5,400.00        Provider
97799        FS=$5,700.00        Provider
97799        FS=$5,400.00        Provider
97799        FS=$5,400.00 / for provider        Provider
97799        FS=$5,400.00 / for provider        Provider
97799 86        FS=$5,640.00 / Additional $5,086.50 awarded to Provider        Provider
97799 86        FS=$5,640.00 / Additional $1,129.00 awarded to Provider        Provider
97799 86        FS=$2,375.00 / Additional $1,625.00 awarded to Provider        Provider
97799 86        FS=$5,400.00 / Additional $2,736.45 awarded to Provider        Provider
97799 -86 (2014)        FS=$5,771.25        Provider
97799 -86 (2014)        FS=$5,130.25        Provider
97799 -86 (2014)        FS=$2,327.00        Provider
97799 modifier 86        FS=$2,250.00-  additional $2,008.07 awarded to provider / for provider         Provider
97799 Modifier 86        FS=$2,350.00 – no fee schedule paid usual and customary based on PPO contract / for provider        Provider
97799 modifier 86        FS=PPO=85% of billed charges == $5,100.00 just showed one EOB for UC        Provider
97799 Modifier 86        FS=$2,500.00 – no fee schedule paid usual and customary based on PPO contract 95% of billed charges  / for provider        Provider
97799 Modifier 86        FS=$2,500.00 – no fee schedule paid usual and customary based on PPO contract 95% of billed charges  / for provider        Provider
97799 modifier 86        FS=$2,250.00 / for provider         Provider
97799 Modifier 86        FS=$2,500.00 – no fee schedule paid usual and customary based on PPO contract 95% of billed charges  / for provider        Provider
97799 Modifier 86        FS=$2,500.00 – no fee schedule paid usual and customary based on PPO contract 95% of billed charges  / for provider        Provider
97799 Modifier 86        FS=$2,500.00 – no fee schedule paid usual and customary based on PPO contract 95% of billed charges  / for provider        Provider
97799 Modifier 86        FS=$5,400.00 – no fee schedule paid usual and customary based on PPO contract 95% of billed charges  / for provider        Provider
97799 Modifier 86        FS=$4,320.00 – no fee schedule paid usual and customary based on PPO contract 95% of billed charges  / for provider        Provider
97799 Modifier 86        FS=$2,500.00 – no fee schedule paid usual and customary based on PPO contract 95% of billed charges  / for provider        Provider
97799 modifier 86 (exceeds FS)        FS=$5,400.00 90 percent of billed charges PPO contract / for provider
Provider
97799 modifier 86 (exceeds FS)        FS=$5,400.00  = Additional $3,094.15        Provider
97799 modifier 86 (exceeds FS)        FS=$5,400.00 90 percent of billed charges PPO contract / for provider        Provider
97799 modifier 86 (exceeds FS)        FS=$5,400.00 90 percent of billed charges PPO contract / for provider        Provider
97799 modifier 86 (exceeds FS)        FS=$5,400.00 90 percent of billed charges PPO contract / for provider        Provider
97799 modifier 86 (exceeds FS)        FS=$5,400.00 90 percent of billed charges PPO contract / for provider        Provider
97799 modifier 86 (exceeds FS)        FS=$5,400.00 90 percent of billed charges PPO contract / for provider        Provider
97799 reduced to 99215        FS=129.41        Provider
97799/ reduced to 99215        FS=129.41        Provider
97799-30         FS=881.82        Provider
97799-30         FS=5,771.25        Provider
97799-30         FS=5,710.50        Provider
97799-86        FS=5,771.25        Provider
97799-86        FS=5,771.25        Provider
97799-86        FS=6,198.75        Provider
97799-86        FS=6,198.75        Provider
97799-86        FS=5,771.25        Provider
97799-86        FS=5,700.00        Provider
97799-86        FS=6,198.75        Insurance
97799-86        FS=5,771.20        Insurance
97799-86        FS=5,130.00        Provider
97799-86        FS=$5,640.00        Provider
97799-86        FS=$2,350.00        Provider
97799-86        FS=6,198.75 / additional awarded $3,839.14        Provider
97799-86        FS=$5,640.00        Provider
97799-86        FS=$4,916.25        Provider
97799-86        FS=$4,916.25        Provider
97799-86        FS=$5,400.00        Provider
97799-86        FS=$4,560.00        Provider
97799-86        FS=$4,560.00        Provider
97799-86        FS=$2,375.00        Provider
97799-86        FS=$4,230.00        Provider
97799-86        FS=$6,198.75        Provider
97799-86        FS=$6,198.75        Provider
97799-86        FS=$5,557.50        Provider
97799-86        FS=$6,198.75        Provider
97799-86        FS=900.00        Insurance
97799-86        FS=2350.00        Provider
97799-86        FS=4061.25        Provider
97799-86        FS=5700.00        Provider
97799-86        FS=5343.75        Provider
97799-86        FS=2350.00        Provider
97799-86        FS=5771.25        Provider
97799-86        FS=4,488.75        Provider
97799-86        FS=5,771.25        Provider
97799-86        FS=5,771.25        Provider
97799-86        FS=$4,488.75 / PPO 95% of billed charges        Decision for provider
97799-86 x5        FS=$4,600.00 / insurance paid 0 stated services not documented         Award of $4,600.00 to provider 0 initially paid
98940        FS=$36.22        Insurance
98943 /97014 / 97250 / 97026        FS=33.89 / 33.21 / 9.23 / 4.61        Provider
99070        FS=0 / Contract violated         Insurance
99070        FS=0        Insurance
99070        FS=Varies        Provider
99070        FS=0        Insurance
99070        FS=0        Insurance
99070 / NDC 0060338912 x60        FS=38.08        Provider
99070 / NDC 11383027104        FS=0 Failed to submit invoice or pricing        Insurance
99070 /11383027104        FS= no invoice        Insurance
99070 NDC 00093001298        FS=0        Insurance
99070 NDC 76218121910        FS=Coding wrong         Insurance
99080        FS=0        Insurance
99080        FS=$154.83 / for provider        Provider
99080        FS=0 / for insurance        Insurance
99080        FS=$131.61 / for provider        Provider
99080        FS=$154.83 / for provider        Provider
99080        FS=$157.78        Provider
99080        FS=0        Insurance
99080        FS=$146.68        Provider
99080        FS=37.98         Insurance
99080        FS=0 / insurance        Insurance
99080 / 99355        FS=39.98 / 90.10        Insurance
99080 / 99358 / 99086        FS=0        Insurance
99080 86 / 99358        99080 86=$37.22 / 99358=$142.45        Insurance
99080x36 (DOS 2013_        FS=787.46        Provider
99081        FS=$11.69 / for provider         Provider
99081        FS=11.46 / for provider        Provider
99081        FS=$11.69        Provider
99081        FS=$9.94        Provider
99081 / 99070        FS=11.69 / 18.05        Provider
99085 / 99080 / 99358        FS=99085=0 / 99080=$11.69 / 99358=0        Insurance
99086 / 99080 / 99358        FS=0        Insurance
99086 / 99085 / 99080 / 17999        FS=99086=0 / 99085=0 / 99080=0 / 17999=$500.00 / for insurance        Insurance
99199        FS=0 no Documentation         Insurance
99199        FS=0        Insurance
99199        FS=0        Insurance
99199        FS=0        Insurance
99199        FS=0        Insurance
99199        FS=0  Medical record review not 99199        Insurance
99199 / 95934 / 95927 / 95903        FS=/0 /$136.71 / 0 / $757.20        Provider
99199 / WC007        FS=0 / Bundled under Evaluation and Management Services        Insurance
99203 / 99080        FS=$93.47 / 99080= 0 / for insurance company        Insurance
99203 / 99354 / 99358 / 99080        FS=99203=$95.55 / 99354=$157.50 / 99358=0/ 99080=0  / for provider        Provider
99203 / 99354 / 99358 / 99080         FS=99203=$105.11 / 99254=0 / 99358=$401.19 / 99080=0 / for provider        Provider
99203 / Billed 99244        FS=$88.28        Insurance
99203 / Billed 99244        FS=$88.28        Insurance
99204        FS=181.55         Provider
99204 / 99358         FS=134.43 / FS=$133.73        Provider
99204 / B=33245        FS=$152.69 / for insurance        Insurance
99204 / Consolidated 14 Claims         FS=$181.55        13 out of 14 awarded provider additional monies
99205        FS=0        Insurance
99205 / 99354 / 99358        FS=99205=$186.73 / 99354=$171.19 / 99358=$218.04        Insurance
99212         FS=$42.02 / Provider awarded $42,02        Provider
99212        FS=0        Insurance
99212        FS=$39.07 / For insurance        Insurance
99212 / A4550 / 17999        FS=0        
99212 m-93 / B=99244        FS=$46.22 /for insurance        Insurance
99212-25        FS=0        Insurance
99213        FS=0        Insurance
99213        FS=$62.63        Provider
99213        FS=$51.24 / for insurance        Insurance
99213        FS=$54.08        Insurance
99213        F=$51.24 / for insurance        Insurance
99213        FS=$57.08        Provider
99213        FS=$62.62        Insurance
99213        FS=0        Insurance
99213        FS=$52.38 / for provider        Provider
99213        FS=0 / for insurance        Insurance
99213 / 99081        FS=99213=$56.93 / 990801=$11.69 / for provider        Provider
99213 / 99081        Refused to review stated no proof of authorization provided / for insurance         Insurance
99213 / 99358        FS=$54.08 / $34.52        Provider
99213 / Billed 99214        FS=$56.93        Provider
99213 / billed as 99215        FS=$56.93        Provider
99213 /Billed 99244        FS=$52.38        Insurance
99213-25 /99214-25        FS=82.44        Provider
99214        FS=112.63        Provider
99214        FS=112.63        Provider
99214        FS=84.99        Provider
99214        FS=84.99        Provider
99214        FS=125.19        Provider
99214        FS=125.14        Provider
99214        FS=112.30        Provider
99214        FS=112.30        Provider
99214         FS=76.49        Insurance
99214         FS=0 / for insurance        Insurance
99214        FS=$54.08 lack of documentation / for insurance        Insurance
99214        FS=$76.13 / for provider        Provider
99214        FS=$83.30 / Provider awarded $83.30        Provider
99214        FS=$89.57 / additional awarded $39.14        Provider
99214        FS=$80.61        Provider
99214        FS=$89.57        Insurance
99214        FS=$85.09 / for provider        Provider
99214        F=$89.57 / for insurance        Insurance
99214        F=$89.57 / for provider        Provider
99214        FS=88.68        Insurance
99214        FS=$87.78  / for insurance        Insurance
99214        FS=$52.38        Insurance
99214        FS=$80.61        Insurance
99214        FS=$83.30 / for insurance         Insurance
99214        FS=0 / for insurance        Insurance
99214        FS=$89.57 / for provider        Provider
99214        FS=125.14        Provider
99214        FS=84.99        Insurance
99214 / 99354        FS= $82.40 / FS=$157.49 / For Provider        Provider
99214 / billed as 99215        FS=$89.57        Provider
99214 / billed as 99215        FS=$89.57        Provider
99214 / WC002        FS=125.14 / 11.91        Provider
99214 / WC002 / 99070 ( NDC 54162054004)        FS=125.14 / 11.91 / 00.00        Provider
99214 / WC002 / 99070 ( NDC 6516202711)        FS=84.89 / 11.91 / 00.00        Provider
99214 -25        FS=84.99        Provider
99214-24-57 / 99354        FS=0 No documentation as to time spend with  patient         Insurance
99214-25 / 62368        FS=58.28 /57.96        Provider
99214-25 / 62368        FS=89.53 /57.96        Provider
99214-93        FS=98.53        Provider
99215        FS=$142.00        Provider
99215        FS=163.00        Provider
99215        FS=0 / for insurance (not considered significant and separately identified   services unrelated to a post-operative visit  / for insurance        

Insurance
99215        FS=118.88        Provider
99215        FS=0 / for insurance        Insurance
99215        FS=$126.82  / for provider        Provider
99215         FS=$110        Insurance
99215        FS=$56.93        Provider
99215        FS=0        Insurance
99215        FS=0        Insurance
99215 – 25        FS= No Medical records        Insurance
99215 (2014)        FS=167.15        Provider
99215 / 99081 / 99401         FS=0        Insurance
99215 / 99215  (25)        FS=$126.82  / $126.82 / for provider        Provider
99215 / 99358        FS=0        Insurance
99215 / 99358 / 73130 / 76140        FS=0        Insurance
99215 / 99358 / 99401 / 99080        FS=0 / could not review MPN issue         Insurance
99215-25        FS=126.82        Provider
99215-93 /99358-59 /99081        FS=$142.5 / $145.36 / $11.69        Provider
99216        FS=57.61 / for Insurance        Insurance
99231 / billed=99244        FS=$56.93 / Provider        Provider
9924 / 99080 / 95832 / 95832        FS=99214=$89.57 / FS=99080=$154.83 / 95832=0 / 95832=0 / for provider        Provider
99243        FS=$32.06        Insurance
99243        FS=$125.04        Insurance
99244        FS=$131.62 / for insurance         Insurance
99244        FS=$189.12        Provider
99244 / 99080 / 99358        FS=99244=$157.13 / 99080=$131.61 / 99358=0 / for provider        Provider
99244 / 99080 / 99358        FS=99244=$157.13 / 99080=$131.61 / 99358=$154.45 / for provider        Provider
99245        FS=131.62        Insurance
99245 / 99080        FS=99245=$125.00 / 99080=$147.09 / for provider        Provider
99245 / 99358 / 99080        FS=$125.04 / $172.62 / $147.08        Provider
99245; 99080; 99358; 99354        FS=99215=$122.94 / FS=99081=11.11 / FS=99358=$76.58 / FS=99354=0 for provider        Provider
99245; 99358; 72114; 72220        FS=99245=$143.27 / 99358=$65.41 / 72114=$36.58 /72220=$19.48 / for insurance         Insurance
99248 / 99354 / 99355        FS=197.20 /144.16 /72.08 provider  paid 0 for last 2        Provider
99320 / 93325        FS=$157.16 /$110.08        Provider
99354        FS=114.35        Provider
99354        FS=0        Insurance
99354        FS=171.19         Provider
99354        FS=171.19         Provider
99354        FS=114.35        Provider
99354        FS=114.35        Provider
99354        FS=0 / for insurance        Insurance
99354        FS=0 / for insurance medical reports did not support services        Insurance
99354        FS=$154.07        Provider
99354        FS=$157.50        Provider
99354        FS=$154.07 / provider        Provider
99354 (1) / 99358 (12) / 99080 (2)        FS=99354=$167.77 / 99358=$427.36 / 99080=$495.27 / for provider        Provider
99354 / 99358        FS=99354=$157.49 / 99358=0        Insurance
99358        FS=0        Insurance
99358        FS=$523.00 90% PPO contract = / for provider        Provider
99358        FS=$109.02 / for provider        Provider
99358        FS=$1,598.96 – additional $1,235.56 awarded         Provider
99358        FS=$138.10        Provider
99358        FS=$218.14; additional $218.40         Provider
99358        FS=0 / for insurance lack of documentation         Insurance
99358        FS=$71.23        Provider
99358        FS=0        Insurance
99358        FS=$123.56        Provider
99358        FS=$106.84        Provider
99358        FS=$251.38        Provider
99358        FS=$163.53        Insurance
99358        FS=$988.45        Provider
99358        FS=$294.35        Insurance
99358        FS=$$425.18        Provider
99358        FS=$72.68        Provider
99358        FS=$436.08        Provider
99358        FS=$436.08        Provider
99358        FS=$89.57 / Insurance        Insurance
99358        FS=$30.89 / for provider        Provider
99358 (1 unit)        Fs=$34.52 / for provider        Provider
99358 / 99080        FS=99358=$142.45 / 99080=0        Provider
99358 / 99080 reduced   to WC 007        FS=157.69        Provider
99358 / 99359        FS=0 / 2014 not payable        Insurance
99358 / 99539 X29        FS=124.90 / 0        Provider
99358 / 99539 X5        FS=124.90 / 301.85        Provider
99358 / B=99212        FS=$66.86 / for Provider        Provider
99358 / Billed 99243        FS=$261.65        Insurance
99358; 99080        FS=99358=$145.36 / 99080=$10.75        Provider
99371        FS=$12.66        Insurance  
99373        FS=0 / not enough information in record        Insurance
99373 / 90862        FS=0        Insurance
99373 / 99081        FS=99373=$64.80 / 99081=$11.46 / for provider        Provider
99412 / WC002 ) (DOS 2014)        FS=125.15 11.91         Provider
99499        FS=10,000.00        Provider
99499        FS=5,000.00        Provider
99499        FS=4000.00        Provider
99499        FS=4000.00        Provider
99499        FS=3,808.00 – full awarded provider        Provider
99499        FS=$2,760.00 / insurance paid 0 sated unlisted /BR not documented         $2,760 award to provider / insurance made no initial payments
99499-86                FS=$5,605.00 additional $2923.45 awarded        Decision for provider
99499-86                FS=$5,605.00 additional $1,381.70 awarded        Decision for provider
99499-86                FS=$5,605.00 additional $1,381.70 awarded        Decision for provider
99499-86                FS=$5,605.00        Decision for provider
ASC  Services         FS=$9,563.89        Provider
ASC Facility Fees        FS-$4,586.94 / additional amount awarded $978.22        Provider
ASC Facility Services        FS=$6,399.00 / for insurance        Insurance
ASC Facility Services (25115)        FS=$1,437.22 / for provider        Provider
ASC Service        FS=$4,865.09 / for insurance        Insurance
ASC Service        FS=$2,455.50 / for insurance        Insurance
ASC Service        FS=$2,146.45 / for provider        Provider
ASC Services        FS=$5,347.57 / for insurance        Insurance
ASC Surgical Services / and 81025        FS=5,861.46 / for insurance  - insurance over paid        Insurance
Billing code        Outcome         Prevailing Party
Billing code        Outcome         Prevailing Party
Compound        FS=0 / No Invoice        Insurance
Compound  /J3490        FS=0 / no Invoice        Insurance
Compound Medication / Prialt 18860072010        FS=Compound=$321.00 / 1886007210=$643.81 / for provider        Provider
Consolidation DME        Decision for the Provider        Provider
DRG 042        FS /PPO=$48,252.40 / 30% of billed charges         Provider
DRG 289        FS=30,434.15 / applied stop loss        Insurance
DRG 30        FS-awarded additional for implants by law         Provider
DRG 454        FS=67,117.70        Insurance
DRG 454        FS=$93,838.22  no additional allowance         Insurance
DRG 454        FS=$94,843.63  no implants / for insurance        Insurance
DRG 454        FS=$102,547.33        Provider
DRG 454        FS= for implants $16,001.14        Provider
DRG 455        FS=79,164.44 / for insurance        Insurance
DRG 455        FS=$79,169.47  no implants / for insurance        Insurance
DRG 455 / Provider Billed 454        FS=$64,062.03 / for insurance         Insurance
DRG 457        FS=57,310.23        Insurance
DRG 458        FS=$76,681.06 / additional $22,449.05        Provider
DRG 459        FS=$75,938.73 / for insurance        Insurance
DRG 460        FS=$52,244.73 / for insurance implants no paid separately         Insurance
DRG 460        FS=$48,170.45 / for insurance implants not separately reimbursable         Insurance
DRG 460        FS=$45,128.10 / for insurance implants not separately reimbursable         Insurance
DRG 460        FS=$50,504.80  no implants / for insurance        Insurance
DRG 460        FS=$45,128.10        Insurance
DRG 460        FS=$49,184.57        Insurance
DRG 460        FS=$50,705.74        Insurance
DRG 460        FS=$48,170.45        Insurance
DRG 460        FS=$48,170.45        Insurance
DRG 460        FS=$48,289.28 / For Insurance        Insurance
DRG 460        FS=$48,165.00 / For Insurance        Insurance
DRG 460        FS=$50,705.74 / for insurance        Insurance
DRG 460 – spinal implants        FS=$45,128.11 paid by insurance no additional allowance for implants        Insurance
DRG 460 Revenue Code 274 (L0464 / L2830)        FS= L0464 / L2830=$1,219.94 / for provider         Provider
DRG 464        FS=46,323.64 / no ppo discount for work comp additional $25,726.46        Provider
DRG 472        FS=$34,843.04 / requesting implants         Insurance
DRG 473        FS=$40,543.47 / for insurance         Provider
DRG 473        FS=25,985.58        Insurance
DRG 473        FS=$26,532.64 / for insurance implants not separately reimbursable         Insurance
DRG 473        FS=$25,985.58  no implants / for insurance        Insurance
DRG 473         FS=$25,985.58 / for insurance  - implants included        Insurance
DRG 473        FS=$ no show no fee for implants        Insurance
DRG 473        FS=$25,985.58        Insurance
DRG 473        FS=$48,170.45        Insurance
DRG 490        FS=no invoices for implants provided        Insurance
DRG 491        FS=$12,477.51 / for provider        Provider
DRG 493        PPO Discount Applied –Price sheet Submitted        Insurance
DRG 494        FS=$30,951.77  -- additional $15,391.98        Provider
DRG 494        FS=30,951.71 additional $15,391.98 / for provider        Provider
DRG 494 274 (L1832)        FS=628.76 / Awarded $628.76        Provider
DRG 918        FS=1,800.00        Insurance
DRG 945        FS+15,382.18  -provider attempted to get 100 percent of billed charges as a rehab unit / services        Insurance
DRG-472        FS=$48,165.00 / For Insurance        Insurance
E0114 / 29881 / 29876 / 29870 / 27570 / 20610        FS=Varies         Provider
E0215        FS=72.00        Provider
E0215        FS=72.00        Provider
E0215        FS=$62.00 / for provider        Provider
E0730 NU        FS=371.98        Provider
E0748        FS=1,591.25        Insurance
E0748        FS=$5,055.04 / Additional $3,355.04        Provider
E1399        FS=$330 / Provider awarded $330.00         Provider
E1399        FS=$3,300.00 / for provider        Provider
E1399  LL (3 units)         FS=$990 billed charges == / for provider        Provider
E1399 (LL) (6)        FS=$1,980.00 for provider an additional $1,446.17         Provider
E1399 LL        FS=$247.50 / Additional $141.75        Provider
E1399 LL        FS=$2,970.00 / Additional $2,071.36        Provider
E1399 LL        FS=$330.00/ Additional $330.00        Provider
E1399 LL        FS=$1,980.00/ Additional $1,710.39        Provider
E1399 LL        FS=0 / Authorized but no documentation  as to cost         Insurance
E1399 LL        FS=$661.32 Additional $661.32        Provider
E1399 LL        FS=$ 1,880.15 Additional $1,800.15        Provider
E1399 LL        FS=$792.00        Provider
E1399 LL        FS=$3,300.00 – additional $1,014.00 to provider        Provider
E1399 LL (7 units)        FS=2,310.00 no objection or documents by insurance / for provider        Provider
E1399 modifier LL        FS=990.00 / for provider        Provider
E1399 modifier LL (3 units)        FS=$990.00 – additional award $693.42 to provider / for provider        Provider
E1399 Modifier LL 1 unit        FS=$330.00 for provider        Provider
E1399LL        FS=742.50 / 742.50 awarded to Provider        Provider
E1399LL        FS=247.50 / Awarded to Provider $247.50        Provider
E1399-LL        FS=$330.00 / Additional $230.15 for provider        Provider
E1399-LL        FS=$2,970.00 / Additional $2,,970.00 for provider / 0 paid        Provider
E1399-LL        FS=$2,970.00 / Additional $2,,970.00 for provider / 0 paid        Provider
E1399-LL        FS=$3,300.00        Provider
E1399-LL        FS=$3,300.00 / Additional $2,,026.89 for provider         Provider
E1399-LL        FS=$1,980.00        Provider
E1399-LL        FS=$1,986.00 / Additional $1,566.for provider         Provider
E1399-LL        FS=0 no proof of authorization          Insurance
E1399-LL        FS=$999.00 / Additional $615.00 provider         Provider
E1399-LL        FS=$2,227.75  / Additional $969.39.for provider         Provider
E1399-LL        FS=$247.50  / Additional $157.63.for provider         Provider
E1399-LL        FS=$1,485.00 additional $975.76 awarded          Provider
E1399-LL (2014)        FS=$3,300.00 / additional $3,200.05 awarded provider        Provider
EL399-LL        FS=$792.00        Provider
G0260 Modifier 50        FS=G0260 Modifier 50 $943.98 / for provider        Provider
G0378        FS=1,098.94        Insurance
G0431        FS=107.14 / additional $85.71 awarded Provider        Provider
G0431        FS/ PPO= $61.79 / additional awarded / $49.76         Provider
G0431        FS=50.33        Provider
G0431        FS=119.94 /         Provider
G0431        FS/ PPO= $119.94 / additional awarded / $95.50         Provider
G0431        FS/ =$107.96 / additional awarded / $98.95         Provider
G0431        FS=$113.94 additional $97.15        Provider
G0431        FS=107.95        Provider
G0431        FS=$119.94 / Additional $108.68        Provider
G0431        FS=$119.34        Insurance
G0431        FS=$107.95 / Additional $86.36        Provider
G0431        FS=$107.95 / Additional $86.36        Provider
G0431        FS=$119 – additional $5094        Provider
G0431        FS=119.94        Provider
G0431        FS=$107.95 / for provider        Provider
G0431        FS=113.09        Provider
G0431        FS=107.14        Provider
G0431        FS=107.14        Provider
G0431        FS=107.14        Provider
G0431        FS=119.95 / Additional $97.15        Provider
G0431        FS=102.95 / Additional $85.16 to Provider        Provider
G0431        FS=119.04        Provider
G0431        FS=$119.94 . for provider         Provider
G0431        FS=$119.94        Provider
G0431        FS=$113.95        Provider
G0431        FS=61.79 / for Insurance        Insurance
G0431        FS=$119.92 / for insurance        Insurance
G0431        FS=$107.95
Provider
G0431        FS=$119.94        Provider
G0431        FS=$113..94        Provider
G0431        FS=$119.94        Provider
G0431        FS=$101.95        Provider
G0431        FS=$101.95        Provider
G0431        FS=$119.94        Provider
G0431        FS=$101.95        Insurance
G0431        FS=$119.94        Provider
G0431        FS=$119.94        Insurance
G0431        FS=$119.94        Provider
G0431        FS=$101.96        Provider
G0431        FS=$101.96        Provider
G0431        FS=$119.94        Insurance
G0431        FS=$119.94        Provider
G0431        FS=$119.94 / Provider        Provider
G0431 / 82055 / 82570        FS=119.00        Insurance
G0431 / 82055 / 82570        FS=$119.94 / $17.82 /$8.353        Provider
G0431 / 82055 / 82570        G0431=101.95 / 82055=$15.15 / 82570=7.25 / for insurance        Insurance
G0431 / 82055 / 82570 // Billed as: 82145 / 82205 / 80154 / 82520 / 83840 / 83992 / 83925-59 / 82145-59 / 82055 / 82570        FS=$113.94 / $16.93 / $8.10        Insurance
G0431 / 82570 / 82055        FS=$113.95 / 82570=$7.68 / 82055=$16.04 / for provider        Provider
G0431 / Billed = 82055 / 82145 / 80154 / 80299-59 /82520 / 80299-59 / 83840 / 83925-59 9x2 0 / 83986 / 83992 / 81002 /80152 /        FS=G0431=$119.94         Provider
G0431 / Billed = 82055 / 82145 / 80154 / 80299-59 /82520 / 80299-59 / 83840 / 83925-59 9x2 0 / 83986 / 83992 / 81002 /80152 /        FS=G0431=$119.94         Provider
G0431 / Billed = 82055 / 82145 / 80154 / 80299-59 /82520 / 80299-59 / 83840 / 83925-59 9x2 0 / 83986 / 83992 / 81002 /80152 /        FS=G0431=$107.95         Provider
G0431 / Billed = 82055 / 82145 / 80154 / 80299-59 /82520 / 80299-59 / 83840 / 83925-59 9x2 0 / 83986 / 83992 / 81002 /80152 /        FS=G0431=$119.94         Provider
G0431 / Billed = 82055 / 82145 / 80154 / 80299-59 /82520 / 80299-59 / 83840 / 83925-59 9x2 0 / 83986 / 83992 / 81002 /80152 /        FS=G0431=$113.95         Provider
G0431 / Billed 8000 codes        FS=119.94 / for Provider        Provider
G0431 / Billed 81002 / 82055 / 83986        FS=$113.94        Provider
G0431 / Billed 82486        FS=$119.94        Insurance
G0431 / Billed at 8000 codes        FS=$107.95        Provider
G0431 / Billed at 8000 codes        FS=$107.95        Provider
G0431 / Billed several 8000 codes        FS=107.95        Provider
G0431 / billed varies 8000 codes         FS=107.95        Provider
J0735 NCD 387790567790, J01170 NCD 38779073105        FS=varies        Provider
J2275 / 62991140305        FS=29.60 provider billed $4,400.00        Provider
J7325 NDC58468009001        FS=490.87 / 490.87 awarded to provider APC separate payments          Provider
L0635        FS=$735.37  / for provider        Provider
L0635 /DRG 460        FS=735.37         Provider
L1990 / and Outlier for Outpatient         FS=L1900=$423.75 / Outlier FS=$3,968.34 paid / for provider        Provider
L3807-NU        FS=0        Insurance
L3908        FS=$81.90 / Insurance        Insurance
L4360 / and Outlier for Outpatient         FS=L4360=$230.21 / Outlier FS=$3,975.02 paid / for provider        Provider
L8680        FS=0 wrong date on invoice        Insurance
L8680        FS=0 wrong date on invoice        Insurance
L8699        FS=0 Packaged in APC        Insurance
L86999 / C9399         FS=0 / bundles for insurance        Insurance
ML 101-95        FS=812.50 adjuster refused payments stated not part of MPN provider awarded $812.00        Provider
ML 102        FS=0        Insurance
ML 102        FS=$625.00        Insurance
ML 102 / ML 104        FS=0        Insurance
ML 102 Billed 103        FS=$625.00        Insurance
ML 102 Billed 103        FS=$625.00        Insurance
ML 102-86 / billed at 103-86-94        FS=$781.25        Insurance
ML 102-94        Fs=628.76        Provider
ML 103        FS=$937.50        Insurance
ML 103        FS=$937.50        Insurance
ML 103 / Billed 104        FS-$937.50        Insurance
ML 103 / Billed 104-95        FS=$937.50        Insurance
ML 103 / Billed 104-95        FS=$937.50        Insurance
ML 103 /93/95        FS=$1,031.25 / for provider        Provider
ML 104        FS=10,842.00 / additional 7,342.00 awarded         Provider
ML 104        FS=4,187.50        Insurance
ML 104        FS=2,625.00 / additional $2,000.00        Provider
ML 104        FS=962.00        Insurance
ML 104        FS=$4,000.00 / $4,000.00 awarded to provider – adjuster denied said ML was not authorized         Provider
ML 104        FS=$9,812.50   / additional $8.875.00  awarded        Provider
ML 104 (46) / 96100        FS=ML104=$2,875.00 / 96100=$299.73 / for insurance        Insurance
ML 104 (90801 and 99358 8 units        FS=$483.94 / for provider        Provider
ML 104 / 96101 / 96116        FS=0        Insurance
ML 104 / Changed to 103        FS=937.50        Insurance
ML 104 / Reduced to 103        FS=937.50        Insurance
ML 104 ? to 102        FS Varies         Provider
ML 104 93 units        FS=$5,812.50 / for provider        Provider
ML 104 94        FS=$5,875.00 / for insurance        Insurance
ML 104 Modifier 94 (62 units)        FS=$4,843.75 for Insurance        Insurance
ML 104 modifier 94 and 95        FS=$2,343.75 == $920.31 amount of PPO discount not allowed / for provider         Provider
ML 104 Modifier 95 (23) units        FS=$1,437.50 / for provider        Provider
ML 104 reduced to 103        FS=937.50 ML103        Insurance
ML 104-93        FS=$825.39        Insurance
ML 104-93 / 95        FS=1,812.50 / O initial payments provider awarded $1,812.50        Provider
ML 104-94        FS=5,312.40        Provider
ML 104-94 /96100        FS=18,937.50 /4,734.38 / 543.06        Provider
ML 104-95        FS=$10,000.00 / $10,000.00 awarded to provider        Provider
ML 106 -93        FS=0 / no documentation as time spent        Insurance
ML 106 Mod 94 / ML 100 Mod 94        ML106 (unis 7) $100.00 / ML 100 FS=0 / for insurance company        Insurance
ML 106-95        FS=0 Did not establish initial medical legal        Insurance
ML=103 reduced to ML 101        FS=$625.00 / for insurance        Insurance
ML=104 95 (20)        FS=$1,250.00 / for provider        Provider
ML0104 94 / 99070        FS=Reduced to ML 103 upheld at $1,484.4 99070=$1.80 / for insurance        Insurance
ML-101-92         FS=3000        Provider
ML101-95 / Reduced ML 102        FS=625.00        Insurance
ML102        FS=0        Insurance
ML-102        FS=0 / for insurance        Insurance
ML102-95        FS=$625.00        Insurance
ML103-93        FS=$625.00        Insurance
ML104        FS=6,796.88 / 6,110.81 additional awarded Provider        Provider
ML104        FS=7,750.00  /additional 6,500.00        Provider
ML104        FS=2,312.50 / insurance said not part of MPN – does not have to be        Provider
ML104        FS=1,500.00`        Insurance
ML104        FS=18,042.50 / additional $13,292.50 awarded        Provider
ML104 95-93 (93 not met)        FS=937.50        Insurance
ML104 Modifies 95        FS=$937.50 / for provider         Provider
ML-104-94        FS=10,842.00 / Additional $7,342.00        Provider
ML104-95        FS=$4,000.00 ($4,000.00 awarded to provider adjuster denied any payments stating not authorized         Provider
ML104-95        FS=$1,875.00 ($1,875.00 awarded to provider adjuster denied any payments stating not authorized )        Provider
ML104-95        FS= Changed to 102 687.50        Insurance
ML104-95 / Reduced to ML103-95        FS=937.50        Insurance
ML104-95 / to ML102        FS=625.00        Insurance
ML106-94 /Ml 104        FS=3,125.00        Provider
Modifier  93 / interpreter         FS=0 / no documentation         Insurance
Modifier  93 / interpreter         FS=0 / no documentation         Insurance
Modifier  93 / interpreter         FS=62.50         Provider
Modifier  93 for ML102        FS=0 Interpreter not certified         Insurance
NDC62991140706        FS=$23,100.00        Insurance
Outpatient Hospital Emergency Room Services        FS=PPO=$58,201.92  / for provider        Provider
Outpatient Surgical Services        FS=$8,523.09 / for insurance        Insurance
Revenue Code 278 HCPCS C1713        FS=0 stating part of surgery no payment allowed        Insurance
WC00        FS=11.19        Insurance
WC004        FS=0 not for secondary treator        Insurance
WC004        FS=329.95        Provider
WC007 / 99203-93        FS=84.99 / 0        Insurance
WC No Lien, No IBR Fee, Getting Paid and Getting
Treatment Authorized -- Video Below as Method Below
March  04, 2015 WC: PPO Contracts- Some Providers Using
Them to Their Benefit.
8 WEEK 24 LESSON COURSE  IN WORK COMP TREATMENT AND
COLLECTIONS for $325.00 (INDIVIDUAL OR ENTIRE STAFF)
March  5, 2015: Medical Necessity
ANTERIOR L5 -S1 LUMBAR FUSION W/
INSTRUMENTATION, USE AUTOGRAFT
AND/OR ALLOGRAFT:
8 WEEK 24 LESSON COURSE  IN WORK COMP
TREATMENT AND COLLECTIONS for $325.00
(INDIVIDUAL OR ENTIRE STAFF)
Or will come to your location for 4 hour for
same fee as course,  for  lecture and
organizing  you collection and treatment
disputes
March 10, 2015: Authorization Issues: URINE DRUG
SCREEN :Overturned
March 10, 2015: Authorization Issues: 1 DEBRIDEMENT
OF THE RIGHT SHOULDER AND BICEP TENODESIS
March 10, 2015: Authorization Issues: 14 ADDITIONAL
DAYS AT THE SKILLED NURSING FACILITY
March 17, 2015: How to Get ACUPUNCTURE  
Authorized
March 17, 2015: How to Get BIOFEEDBACK
Authorized
March 17, 2015: How to Get: AQUA THERAPY
Authorized  
March 17, 2015: How to Get BLOOD PRESSURE
CUFF Authorized
March 17, 2015: How to Get BONE
STIMULATOR   Authorized
March 17, 2015: How to Get CARDIAC
CLEARANCE  
   Authorized
March 17, 2015: How to Get CARDIOLOGY
CONSULT     
   Authorized
March 17, 2015: How to Get CHIROPRACTIC    
Services   Authorized
March 17, 2015: How to Get COGNITIVE
BEHAVIOR THERAPY   Authorized
March 17, 2015: How to Get
  • EKG    
  • ELECTROENCEPHALOGRAPHY (EEG)
  • ELECTROMYOGRAM  EMG
  • (ELECTROMYOGRAPHY) EMG/NCS   
March 17, 2015: How to Get FUNCTIONAL
RESTORATION PROGRAM: INITIAL EVALUATION
Authorized
March 17, 2015: How to Get  Extracorporeal Shock
Wave Treatment  / Shock Wave Therapy   Authorized
March 17, 2015: How to Get  Medications / compounds /
Etc.   Authorized
March 17, 2015: How to Get  Urine drug Screen.   
Authorized
March 17, 2015: How to Get . PSYCHOTHERAPY  
Authorized
March 17, 2015: How to Get .  PSYCHE TREATMENT
Authorized
March 17, 2015: How to Get PHYSICAL THERAPY.   
Authorized
March 17, 2015: How to Get .PAIN MANAGEMENT    
Authorized
March 17, 2015: How to Get .OCCUPATIONAL
THERAPY   Authorized
March 17, 2015: How to Get  OCCUPATIONAL
THERAPY   Authorized
March 23, 2015: Paper: WC Denial of Treatment:
Interpretation of IMR Data Wrong, and Wrong.
March 23, 2015: WC: Are Injured Workers Being
Denied Necessary Medications?WC: Are Injured
Workers Being Denied Necessary Medications?
March 23, 2015; Paper: WC Authorization,
Providers Forgetting Who the Experts Are: They
Are!
March 23, 2015: Paper: “Petition Non-IBR
Medical Legal Dispute” Confusing to Be Effective?
March 23, 2015: WC: Attacking Providers Quality
of Care, ---- Insane Statements
MEDICATION NORCO
Common errors: from IMR (Independent Medical Review) Decisions) Not From The Insurance Companies UR Review.
The Below Represents 10s of thousands of common errors, omission and lack of documentations

   Absence of documented exact amount of medication prescribed in the prior PR reports and the duration exceeded the Amount
recommended in the guidelines ,MTUS Chronic Pain Treatment Guidelines Opioids, Opioids for chronic pain Page(s): 75,80.

   No evidence of objective functional improvement as a result of the ongoing use of this medication.

   There is also no frequency listed in the current request.MTUS Chronic Pain Treatment Guidelines Page(s): 74-82

   Guidelines, patients must demonstrate functional improvement in addition to appropriate documentation of ongoing pain
relief to warrant the continued use of narcotic medications.

   Submitted documents show no evidence that the treating physician is prescribing opioids in accordance to change in pain relief,
functional goals with demonstrated improvement in daily activities, decreased in medical utilization or change in work status.

   There is no evidence presented of random drug testing or utilization of pain contract to adequately monitor for narcotic
safety, efficacy, and compliance.

   The MTUS provides requirements of the treating physician to assess and document for functional improvement with
treatment intervention and maintenance of function that would otherwise deteriorate if not supported. From the submitted
reports, there is no demonstrated evidence of specific functional benefit derived from the continuing use of opioids with
persistent severe pain. MTUS Chronic Pain Treatment Guidelines Opoids Section Page(s): 74-96.

   The medical records do not contain documentation of participation a functional restoration program and documentation of an
increase in function and specific decrease in pain with the use of narcotic medication.

   Remains unclear how much functional improvement the patient has with previous use of Norco. MTUS Chronic Pain
Treatment Guidelines Page(s):91

   . The guidelines stated that Opioids should be discontinued if there is no overall improvement in function, and they should be
continued if the patient has returned to work or has improved functioning and pain. If tapering is indicated, a gradual weaning is
recommended for long-term opioid users because opioids cannot be abruptly discontinued without probable risk of withdrawal
symptoms and Consideration of a consultation with a multidisciplinary pain clinic if doses of opioids are required beyond what is
usually required for the condition or pain does not improve on opioids in 3 months. Consider a psych consult if there is evidence
of depression, anxiety or irritability. Consider an addiction medicine consult if there is evidence of substance misuse.

   . There is no evidence of objective functional improvement. There is also no frequency listed in the current request. The
request for Norco 10/325mg, sixty count, is not medically necessary or appropriate MTUS Chronic Pain Treatment Guidelines
Page(s): 74-82

   . There is no change in the patient's physical examination that would indicate functional improvement. Satisfactory response
to treatment has not been indicated by a decrease in pain level, increase in function, or improved quality of life.

   The physician visit of September 5, 2013, fails to document any improvement in pain, functional status or side effects to
justify continued

MEDICATION NORCO / Guidelines
Course  Lesson One: Medical Necessity, Authorization, URs,
IMRs Medical Legal, EORs 4 times this week just reg and will
approve - also those that took the course last year


Please register for Lesson One: Medical Necessity, Authorization,
URs, IMRs Medical Legal, EORs on Monday, March 23, 2015 2:
30 PM - 3:30 PM PDT at:

https://attendee.gototraining.com/r/5580869599770933506

This training meets 4 times.
Mon, Mar 23, 2015 2:30 PM - 3:30 PM PDT
Thu, Mar 26, 2015 2:30 PM - 3:30 PM PDT
Fri, Mar 27, 2015 9:30 AM - 10:30 AM PDT
Sat, Mar 28, 2015 9:30 AM - 11:30 AM PDT



Medical Necessity, Authorization, URs, IMRs Medical Legal,
EORs -- We are going to start and master medical necessity --
getting treatment authorized and proving medical necessity - also
Medical Legal and EORs -- as this starts and travels to the path of
all disputes, payments issues and WCAB issues --master this and
it will change collection disputes for the better

After registering you will receive a confirmation email containing
information about joining the training.

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