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Create Paper SBRs - NCPDP

Create paper Second Reviews for pharmacy bills not originally billed through DaisyBill.

The DWC stipulates that a Request for Second Review be submitted in the same manner as the Original Bill.  Use DaisyBill’s Paper SBR functionality to create paper second reviews for bills originally submitted on paper.

Step 1. From Injury Page →  Click ‘Paper SBRs’

Step 2. Click ‘Add Second Review’

Step 3. Enter Date of Service

Enter the date of service of the original bill.

Step 4. Select Prescribing Provider

Prescribing Providers populate from the Prescribing Providers saved in Billing Provider Settings.

Step 5. Select ‘Service or Good Type’

Select ‘Compound / Dispensed’ for pharmaceuticals.  Select ‘Other’ for pharmaceutical services.

Step 5. Enter Service Line Items

NDC Number - Enter 11 digit NDC number of the pharmaceutical.

Units - Enter number of units billed for NDC Number from Original bill.

Charge - Enter the charge amount on Original bill.

Allowed Amount - Enter the amount Allowed by the claims administrator per the original EOR the NDC number.

Authorized? - Select ‘Yes’ if authorization was obtained.

Supporting Documentation Attached? - Check ‘Yes’ if attaching additional documentation not submitted with original bill

Reason for Requesting Second Bill Review - Describe the reason for the second review.  This field is populated directly onto the SBR-1 form. Reason for second review should directly reference denial reason found on original EOR.

 

Step 6. For Compounds: Enter Additional Service Line Items

For Compound pharmaceuticals where more than one ingredient was paid incorrectly, enter each incorrectly paid NDC separately.  Additional lines will automatically populate.  To delete a Service Line Item, click the trashcan icon.

Step 7. Optional: Check ‘Add Dispensing Fee?’

Check Add Dispensing Fee? to include the dispensing fee amount on the second review.

Enter the Charge, Expected, and Allowed Amount.  For help calculating the Expected amount use DaisyBill’s OMFS Calculator and see the Help Article OMFS Calculator - Pharmacy (Compound Pharmaceuticals) and OMFS Calculator - Pharmacy (Single Prescription)

Step 8. Enter Date of EOR

Enter the date the original EOR was issued.  A Provider has 90 days from this date to submit a request for Second Review.

Step 9. Enter ‘Payer Claim Control Number’ → Click ‘Create Second Review’

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

 

Step 10. To Preview Second Review → Click ‘Preview SBR’

Step 11. To Edit Second Review → Click ‘Edit Second Review’

Step 12. To Track Second Review → Click ‘Mark Sent and Download’

Step 13. To Print Second Review → Click ‘Download’ → Print and Send Second Review

Step 14. When Second Review EOR is Received → Click ‘Mark Processed’

Enter amount allowed by claims administrator for second review in Allowed.  Enter date of second review in Processed On.

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