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.

Each Paper SBR download incurs a $1.00 fee.

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

Step 2. Enter the ‘DOS’ and select ‘Prescribing provider’ and ‘Service or good type’

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

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

Step 3. 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.

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.

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

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

Step 4. 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 5. Optional: Check ‘Add Dispensing Fee?’

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

Enter the Charge, Expected, and Payment amounts.  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 6. Enter ‘EOR Date’

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

Step 7. Enter ‘Payer Claim Control Number’, then click ‘Add 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 8. To preview the Second Review, click ‘Preview SBR’

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

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

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

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

Step 12. 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.

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