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Create Paper SBRs

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.

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

The number in parentheses indicates the number of Paper SBRs created for the injury.

Step 2. Click ‘Add Second Review’

Step 3. Enter ‘ Date of Service’, ‘Rendering Provider’ and ‘Place of Service Type’

Step 4. Enter Service / Product information for Second Review

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

Modifiers - Enter if any on original bill.  For help entering multiple modifiers click here.

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 claims administrator for the Procedure Code per original EOR

Authorized? - Check box if service/product previously authorized

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

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

 

Step 5. Enter additional Service/Product for Second Review

List only additional Service/Products billed on the Original Bill. To delete a Service/Product, click the ‘Trashcan’ icon.

Step 6. 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 7. Enter ‘Payer Claim Control Number’, then click ‘Create Second Review’

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

Step 8. To preview the Second Review, click ‘Preview SBR’ link

Step 9. To edit the Second Review, click ‘Edit Second Review’

Step 10. To track the Second Review, click ‘Mark Sent and Download’

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

Step 11. To print the Second Review, click ‘Download’, then print and send

Step 12. When the Second Review EOR is Received, click ‘Mark Processed’

Step 13. 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.

Voila!

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