Injury Page
Injury Page

Create Paper SBRs

Last update
May 26, 2022

Need to create paper Second Reviews?

No problem. Since the DWC stipulates that a Request for Second Review be submitted in the same manner as the Original Bill, use the Paper SBR feature to create paper second reviews for paper bills originally submitted outside of DaisyBill.

Each Paper SBR download incurs a $1.00 fee.

Step 1. From the Injury Page, click ‘Add’ under ‘Paper SBRs’

The number in parentheses next to View is the number of Paper SBRs created for the injury.

Step 2. Enter the ‘DOS’, ‘Rendering Provider’ and ‘Place of Service Type’

Step 3. Enter Service / Product information for Second Review

Procedure Code - To second review a physician dispensed pharmaceutical, use Procedure Code 99070 and provide the NDC Number in the corresponding Supplemental Data field

Modifiers - Enter if applicable on original bill.  For help entering multiple modifiers, see the Help Article: Multiple Modifiers for a Procedure Code.

Units - Enter number of units for service/procedure from original bill

Charge - Enter the amount billed for the Procedure Code per the original bill

Allowed Amount - Enter the amount paid by the claims administrator for the Procedure Code, per the original EOR

Authorized? - Check box if service/product was previously authorized

Supporting Documentation Attached? - Check box if attaching additional documentation not submitted with the original bill

Reason for Requesting Second Bill Review - This field is populated directly onto the SBR-1 form and should directly reference the denial reason found on the EOR.  For help with wording of common denial and incorrect payment reasons, see the Help Topic: Second Review Library.

You have the option of selecting from the ‘Second Review Reasons’ saved in your Library, or you may compose your own Second Review Reason. 

Step 4. Enter any additional Service/Product for Second Review

List only additional Service/Products billed on the Original Bill. Additional Service Line Item fields will appear as you enter information.

To delete a Service/Product, click the ‘Delete’.

Step 5. Enter ‘Date of EOR’

This is the date the original EOR was issued.

A timely Second Review must be submitted within 90 days of this date.

Step 6. Enter ‘Payer Claim Control Number’, then click ‘Add Second Review’

The Payer Claim Control Number is the claims administrator's unique bill identifier. For help locating this number on an EOR, see the Help Article: Payer Claim Control Number.

Step 7. To preview the Second Review, click ‘Preview SBR’

Step 8. To edit the Second Review, click ‘Edit’

Step 9. To track the Second Review, click ‘Download’

This changes the status of the Second Review to ‘Sent’.

Step 10. To print the Second Review, click ‘Download’, then print and send

Step 11. When the Second Review EOR is Received, click ‘Mark Processed’

Step 12. Enter ‘Amount’ and ‘Processed On’ date, then click ‘Mark as Processed’

Amount listed must be the dollar amount received in response to the Second Review.

All done!

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