IBR When No Response to SBR

In April 2017, the DWC Audit Unit confirmed: the DWC accepts Independent Bill Review submissions when a claims administrator fails to timely respond to a Request for Second Review.

Providers may request second review of payment within 90 calendar days of receipt of the claims administrator’s Explanation of Review (EOR). Within 14 days of receipt of the Second Review, a claims administrator must issue a Final EOR with a written determination of each item in dispute.

If the claims administrator fails to issue the Final EOR within 14 days, here’s how to quickly create an Independent Bill Review Submission in DaisyBill.

Step 1. Create a $0 posting for the Second Review Submission

For assistance posting a $0 EOR see the Help Article: Post $0 Reimbursement or Denial.  This makes the bill eligible for Independent Bill Review in DaisyBill.

Step 2. Upload an “EOR” to $0 posting

While no official EOR was provided by the claims administrator an EOR is required to be able to create an IBR Submission.  We’ve created a handy document you can use as an EOR.  Find it here: No Response to SBR.

For assistance uploading an EOR to a posting see the Help Article: Upload / View / Delete Paper EOR.

Step 3. Create IBR Submission

For step-by-step directions on creating an IBR Submission in DaisyBill see the Help Article: Create IBR Submission.

It’s that simple!

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