MAXIMUS Launches Bill Review Services for California Workers’ Comp Program

MAXIMUS, a provider of government services worldwide, announced the launch of operations under two separate two-year contracts with the California Division of Workers’ Compensation to provide independent medical review and independent bill review services.

The combined value of both contracts is estimated to be up to $40 million over the two-year period.

Independent medical reviews are a cost effective non-judicial way to resolve disputes concerning the medical treatment of injured employees served by the California workers’ compensation system. If an injured worker’s physician’s request for medical treatment is delayed, denied or modified by a claims administrator for the reason that the treatment is not medically necessary, the injured employee may ask for an independent medical review of that decision.

Under the Independent Medical Review contract, MAXIMUS professionals will provide independent medical reviews of denied authorization requests or payments for medical services. These reviews are provided by an experienced team of independent professional staff, including nurses, doctors, physical therapists, health appeals specialists and other professional health clinicians.

Under the Independent Bill Review contract the Company will provide review services for payment disputes between providers and claims administrators.

The company already provides independent reviews of health care appeals for the Centers for Medicare & Medicaid Services (CMS), the Department of Veterans Affairs (VA), the U.S. Office of Personnel Management (OPM), as well as more than 44 state regulatory agencies nationwide. Since 1989, MAXIMUS has completed more than two million health care appeals on a timely basis and under rigorous quality control standards.

“This latest contract allows MAXIMUS to grow our independent review business while securing a foothold in a new, adjacent market, which is part of our larger strategy to extend our core capabilities to new programs and agencies,” commented MAXIMUS CEO Richard A. Montoni. “We are drawing on our proven business processes and team of professionals to provide timely, independent reviews for California’s workers.”

Source: MAXIMUS