Experience. Strategy. Resolution.
Workers’ Compensation Claims
MLRS assists medical and healthcare providers with complex workers’ compensation matters that can affect payment for medical services. Our approach combines 16 years of defense-side experience with provider-focused claim analysis, strategic negotiation, and focused resolution of outstanding bills and liens.
Our Process
01 — Analyze
Review the claim, medical records, billing, EORs, correspondence, and relevant medical-legal reports.
02 — Identify
Identify compensability, authorization, medical-necessity, billing, lien, and procedural issues affecting payment.
03 — Strategize
Develop a resolution strategy based on the facts, documentation, applicable requirements, and available negotiation options.
04 — Pursue Resolution
Negotiate where appropriate and pursue necessary filings or WCAB remedies when needed.
Overcoming Workers' Compensation Resolution Challenges
Navigating the complex California workers' compensation landscape requires a strategic approach to medical billing and lien resolution. We provide providers with the expertise needed to manage specific regulatory hurdles and secure accurate outcomes.
Medical Treatment & Billing Compliance
- Strict adherence to Request for Authorization (RFA) timelines and protocols.
- Expert handling of Second Bill Reviews (SBR) and EOR review to address underpayments.
- Application of Medical Treatment Utilization Schedule (MTUS) and resolution of medical-necessity issues.
UR / IMR Strategy & Resolution
- Strategic management of Utilization Review (UR) and Independent Medical Review (IMR).
- Ensuring timely response to clinical inquiries and MTUS compliance.
- Analysis of physician reporting sufficiency for favorable resolution.
QME & AME Evaluation Oversight
- Coordination of QME and AME evaluation processes.
- Ensuring comprehensive evidence presentation for evaluations.
- Addressing reporting defects and request for supplemental reporting.
Lien, DOR & Hearing Resolution
- Lien filing and activation with strategic settlement negotiations.
- Preparation of DOR and representation at WCAB hearings and filings.
- Assessment and pursuit of penalties, interest and costs where applicable.