Glossary of QME report and software terms

By Ahmed Jemaa, Co-Founder and CEO of Medrecords AI. Updated 2026-11-12.

Limits: We read each vendor's own pages and the DWC regulations on 2026-11-12 and did not test any product with real records. Prices change, and nothing here is legal or billing advice.

Evaluator and agency terms

QME (qualified medical evaluator)

A physician certified by the California DWC's Medical Unit to perform medical-legal evaluations in disputed workers' comp claims. QMEs are reappointed periodically, and missing the QME 110 deadline is grounds to deny reappointment (8 CCR 34).

Panel QME

PQME

A QME picked from a panel the DWC issues for a specific claim. On the bill, modifier -95 marks a panel QME evaluation and doesn't change the fee (8 CCR 9795).

AME (agreed medical evaluator)

An evaluator both parties agree on in a represented case. Modifier -94 multiplies the value of ML201 and ML202 by 1.35.

DWC (Division of Workers' Compensation)

The part of California's Department of Industrial Relations that runs the QME program, publishes the QME forms and sets the medical-legal fee schedule in Title 8 of the California Code of Regulations.

EAMS

The Electronic Adjudication Management System, the DWC's case system for workers' comp cases. Some QME software, such as SimpleExam, uses it at intake.

DEU (Disability Evaluation Unit)

The DWC unit that issues summary ratings. In unrepresented cases with impairment, disability or apportionment findings, the QME serves the DEU with the report and forms at the same time as the parties (8 CCR 36(c)).

Fee schedule and billing terms

Medical-Legal Fee Schedule

The fee schedule in 8 CCR 9795 that sets what QMEs, AMEs and treating physicians are paid for medical-legal evaluations and testimony. For most codes, the fee is a relative value times $16.25.

ML201

The billing code for an initial medical-legal evaluation: $2,015, including review of 200 pages of records. Billing it requires a verification of total pages reviewed, under penalty of perjury.

ML-PRR

The code that identifies record review beyond the pages included in an ML code, billed per page under 8 CCR 9795.

Supplemental report

A report written without a new exam, after a party's request or after records arrive that weren't available before; billed as ML203 at $650 and due within 60 days of the request (8 CCR 38(i)).

CMS 1500

The standard paper claim form for professional services. SimpleExam says it auto-fills it; DWC rules don't name a form for medical-legal bills.

EDI (electronic data interchange)

Sending bills and receiving remittances electronically in standard formats. SimpleExam says it submits and tracks bills via EDI.

EOR (explanation of review)

The claims administrator's notice explaining a reduced or denied medical-legal bill, due within 60 days of receiving the bill and report (8 CCR 9794).

IBR (independent bill review)

The step after a second review when a physician still disputes the amount paid, under Labor Code 4603.6. A second review request is due within 90 days of the EOR (8 CCR 9792.5.5).

QME form terms

QME 110

The QME appointment notification form, sent by mail or fax within 5 business days of making the appointment (8 CCR 34).

QME 111

The QME findings summary form for unrepresented cases, which includes the declaration of service (8 CCR 36(b)).

QME 112

The QME/AME report time frame extension request, due no later than 5 days before the 30-day deadline (8 CCR 38).

QME 122

The AME or QME declaration of service of medical-legal report, attached to every report served in a represented case (8 CCR 36(a)).

Proof of service

A signed statement of who was served, how and when. For QME reports it is QME 122 or the declaration on QME 111.

P&S (permanent and stationary)

The point where a condition has stabilized. A P&S finding with permanent partial disability brings DWC-AD Form 10133.36 with the report (8 CCR 35.5).

Software terms

Page citation

A link from a fact in a summary or draft to the page of the record set it came from. It lets you check a line in seconds instead of searching.

Deduplication

Finding pages that appear more than once in a record set, often because several senders forwarded the same document. Some tools bill duplicates and some don't.

BAA (business associate agreement)

The HIPAA contract a vendor signs before handling protected health information for you. Ask for it before the first upload.

Record declaration

The sender's statement under penalty of perjury, with an attested page count, that must come with records sent to a QME; without it, the pages can't be billed (8 CCR 9793(n)).

Rules quoted here were read on dir.ca.gov on 2026-11-12. See the workflow page for how they fit together.