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IBR When No Response to SBR

In April 2017, the DWC Audit Unit confirmed with DaisyBill that the DWC will now accept Independent Bill Review submissions when a claims administrator fails to timely respond to a Request for Second Review.

This news is a boon to providers across the state, as it should pressure claims administrators to adopt compliant Final EOR practices.

So what exactly does this mean? Say you receive an incorrect reimbursement for an original bill. Per section 9792.5.5 of the California Code of Regulations, a provider may request a second review of the payment within 90 calendar days of receipt of the claims administrator’s Explanation of Review (EOR). As you all know, it’s critical to include that EOR in your Request for Second Review.

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.

Here’s how you can quickly create the Independent Bill Review Submission in DaisyBill when a claims administrator fails to respond timely to a request for Second Review.

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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