Maximus has won two contracts worth up to $40 million combined to provide independent medical review and independent bill review services to the California State Division of Worker’s Compensation.
For the first contract, Maximus’ team of health professionals will evaluate denied medical authorization requests or payments to address coverage disputes, the company said Thursday.
Under the second contract, the company will review cases in which a medical provider disagrees with a claims administrator.
Richard Montoni, Maximus CEO, said the company seeks to extend its independent review business across government programs and agencies.
In California, injured employees may ask for independent reviews of decisions by claims administrators to deny a physician’s request for medical treatment because they believe the treatment is not necessary, the company says.
Employees can also ask for a review if the claim is delayed or modified.