In California’s complex workers’ compensation landscape, time is money, and for medical providers, getting paid promptly can mean the difference between a thriving practice and operational strain. Yet, many doctors face frustrating delays in payments due to prolonged Explanation of Review (EOR) processing timelines. At Medical Lien Management (MLM), our proprietary systems and expert workflows ensure that 79% of EORs are processed in under 15 days, significantly outpacing industry averages. The result? Faster payments, fewer disputes, and more revenue in your pocket. So how do we do it, and how can you benefit?

Understanding the EOR Process in California Workers’ Comp

Before we dive into how MLM accelerates EOR outcomes, let’s unpack the concept. The Explanation of Review (EOR) is a critical document issued by claims administrators or insurance companies in response to a medical provider’s bill. It details the amount approved for payment, the amount denied, and the rationale for such decisions. In many cases, the EOR is the first indication a provider receives that their claim may be underpaid or disputed.

Per California’s Labor Code § 4603.3 and 8 CCR § 9792.5.3, insurers must issue an EOR within 15 working days of receiving a complete medical bill. However, in real-world application, many providers see delays that extend far beyond this statutory window, often due to incomplete documentation, coding errors, or bureaucratic bottlenecks within the payer’s processing system. These delays not only impact cash flow but also reduce the window for submitting a Second Bill Review (SBR) or filing for Independent Bill Review (IBR).

Statutory Timelines and Why Speed Matters

The California Code of Regulations outlines strict timelines for workers’ compensation billing. According to CCR § 9792.5.7, once an EOR is received, the provider has 90 calendar days to file a Second Bill Review if they disagree with the payment amount. If the SBR is denied or ignored, the provider has 30 days to escalate the case to IBR, paying a $195 fee that is refundable if the ruling is in their favor.

Missing these deadlines can mean forfeiting thousands of dollars in potential revenue, especially in cases where underpayment was clearly made in error. This is where MLM’s expertise and structured follow-up systems come into play.

Real-World Case: A Pain Management Clinic in Riverside

Dr. S, a pain management specialist in Riverside, submitted bills for a series of epidural steroid injections under CPT code 62323. The claims administrator issued an EOR after 21 days, with partial denials citing non-authorized service and incorrect modifiers. Dr. S’s in-house billing team, overwhelmed with volume, failed to recognize that the 90-day SBR deadline was approaching.

MLM was brought in at this point. After an immediate audit, our team discovered that the original RFA had been approved, but the authorization number was missing from the submission. Additionally, modifiers were applied in accordance with OMFS guidelines but were misinterpreted by the insurer.

How MLM Rescued the Case, and Got Dr. S Paid

Once engaged, MLM:

• Reviewed the original Request for Authorization (RFA) and matched it with the billing submission.
• Corrected the claim format using our certified coding team.
• Filed a detailed Second Bill Review (SBR) with referenced codes: Labor Code § 4603.2 and supporting CPT documentation.
• When the SBR was denied again with a generic reason code, we immediately escalated to Maximus Federal Services via IBR filing, attaching the updated medical notes, RFA approval, and itemized billing.

Using our Jet Filing System, all documents were submitted within 5 hours, ensuring compliance with the statute of limitations. Within 18 days, Maximus ruled in Dr. S’s favor, awarding the full billed amount, plus the return of the $195 IBR fee.

This was not just a win; it was a demonstration of how expert handling, timely intervention, and regulatory precision can recover revenue that would otherwise be lost.

Why MLM Outpaces Industry EOR Timelines

Our ability to process 79% of EORs in under 15 days stems from our:

• Jet Filing System: Our proprietary platform ensures that all claims, RFAs, and SBRs are electronically submitted in structured formats recognized by most claims administrators.
• Certified Coders: Every claim is audited and corrected before submission to eliminate delays.
• Dedicated Legal Team: Our in-house experts prepare appeals, rebuttals, and litigation support that comply with DWC rules and WCAB protocols.
• Real-Time Tracking Dashboards: Clients receive updates on every stage of the claim lifecycle, from submission to resolution.

Visual Title:
“Why MLM Gets You Paid Faster”

Infographic Text:

• Jet Filing
• Certified Coders
• Live Dashboards
• Legal Experts
• 1-Week Billing Response

The Bottom Line: Faster EORs = Faster Payments

Time-sensitive processing of EORs isn’t just a compliance requirement, it’s a financial imperative. At MLM, we go beyond filing claims, we proactively manage, track, and resolve them using an integrated billing and legal approach that’s built for California’s ever-evolving workers’ compensation system.

Whether you’re battling underpayments, stalled reimbursements, or legal pushback, we help you get paid faster, more accurately, and with less stress.

📞 Contact Medical Lien Management today to streamline your billing process and never miss a statutory deadline again. Let us turn your unpaid claims into predictable revenue.