Doctor Management Services recovered 99.6% of a disputed medical-legal balance, turning a denied psychiatric QME invoice into a fully negotiated settlement without litigation.
Who we worked alongside:
Four revenue problems MBC was brought in to fix.
Carrier claimed the report was already reimbursed correctly.
The full $18,400 remained outstanding and unpaid for over three months.
Disputes contested on multiple grounds are often written off well before the 4-to-5-month mark.
Carrier doubted the psychiatric modifiers were applied correctly.
A disputed QME invoice rarely fails because the carrier finds one unanswered gap and stops there. When this $18,400 psychiatric QME invoice was denied in March 2026, DoctorMGT’s approach was to close every gap before the carrier could point to it, building a record too well-documented to keep denying.
Reviewed the supplemental psychiatric report line by line against the California Medical-Legal Fee Schedule, identifying a $6,150 underpayment gap between what was billed and what the carrier had reimbursed.
Audited all three psychiatric modifiers applied to the original submission within the first two weeks of the engagement, confirming none were the source of the carrier’s dispute.
Located and produced dated correspondence proving the original payment had been formally disputed within the required 90-day window, directly countering the carrier’s central argument for non-payment.
Backed each of the 6+ follow-up communications with specific references to applicable California Workers’ Compensation regulations, narrowing the carrier’s room to push back without a documented basis.
Maintained consistent contact with the carrier over 8 weeks, addressing every objection as it surfaced and reinforcing that penalties and interest accruing at a rate that added over $1,900 to the balance would continue the longer it stayed unresolved.
All metrics span January 2026 through April 2026 across both practice service lines.
99.6% Recovered without litigation
End-of-engagement AR profile. Current bucket dominance confirms active follow-up.
63% drop. Primary denying payer: BCBS ($400K+ addressed). Total denial instances: 14,747 across $633,955.
Four distinct objections stood between this provider and payment. Each was addressed with documentation before the carrier agreed to settle.
| CCR §9795 | Carrier claimed the psychiatric report was already reimbursed correctly under | Workers' Comp Carrier | Line-by-line fee schedule recalculation; | Resolved |
| CCR §9794 | Carrier disputed the reimbursement mandate and payment procedure | Workers' Comp Carrier | Cited payment and collection requirements under the reimbursement mandate | Resolved |
| CO-167 | Carrier questioned whether supporting records/communications were properly provided to the evaluator | Workers' Comp Carrier | Confirmed all documentation was communicated per statutory requirements | Resolved |
| CO-133 | Claim submitted without required modifier or with incorrect modifier | CCR §9793 | Carrier disputed procedural definitions used in the original submission | Resolved |
