Non-Contracted Providers and Denied Claims

When an insurance company denies your claim because you’re a non-contracted provider, we recommend that you submit a request for Second Review.

Frequently Asked Question

Q: How should I respond to an insurance company that has denied our claims because we are a non-contracted provider?

A: Payment is not dependent on whether the provider is contracted or non-contracted. Instead, payment depends on whether treatment was authorized by the claims administrator.

Explanation

Senate Bill 1160 amends Labor Code 4610 to clarify that all treatment requires a RFA:

“Unless otherwise indicated in this section, a physician providing treatment under Section 4600 shall send any request for authorization for medical treatment, with supporting documentation, to the claims administrator for the employer, insurer, or other entity according to rules adopted by the administrative director.”

Second Review Reason

UR authorized all billed services. Please reprocess this bill and issue payment. Documented authorization submitted with original bill.  

The authorization is included with this SBR-1 Form.

Attached is a copy of an OVERTURN IBR Decision (link below) indicating this incorrect denial will be overturned when reviewed by IBR.

Additional Information

IBR Case Number: CB16-0000030

Full text of SB 1160

DaisyBill Resources

Webinar: Senate Bills 1160 and 1175

BOOK A DEMO

Was this article helpful?

About Us

DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

Drop us a line with any news you would like us to share or any issue that concerns you.

Read more

Search results for: