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
DaisyBill Resources
Webinar: Senate Bills 1160 and 1175