For incorrectly denied or underpaid Original bills, DaisyBill advises filing a Second Review and including IBR decisions as supporting documentation.
For help determining the correct level of E/M code code and documentation, read DaisyBill’s Work Comp FAQ article: E/M Code Determination: How do I know the right code level for E/M services?
Official Medical Fee Schedule
EOR Denial Reason
This service requires prior authorization and none was identifed.
Second Review Reason (SBR-1 Form)
Evaluation and Management visits do not require prior authorization when performed by the designated Primary Treating Physician (PTP).
Optional: Attached is a copy of an OVERTURN IBR decision indicates that this reimbursement will be overturned when reviewed by IBR.
Recommended Supporting Documents (IBR Decisions)
Webinar: Request for Second Review
Webinar: Second Review Strategy Kit, Part I
Webinar: Second Review Strategy Kit, Part II
Every request for Second Review submitted from DaisyBill is compliantly submitted using both a completed DWC Form SBR-1, as well as a compliant modified CMS 1500.