Incorrect Reimbursement: PPO / Network Reduction Incorrectly Applied

For incorrectly denied or underpaid Original bills, DaisyBill advises filing a Second Review and including IBR decisions as supporting documentation.

Official Medical Fee Schedule

Any

CPT Code(s)

Any

Payable

Yes

EOR Denial Reason

Reduction in accordance with _____ Contract.

This charge was adjusted to comply with the rate and rules of the contract indicated.

Second Review Reason (SBR-1 Form)

Recommended Reason

An incorrect PPO discount rate used when to calculate reimbursement.

Contracted rate is ___%

Accordingly, please review this bill for additional payment per OMFS.

Optional: Attached is a copy of an OVERTURN IBR Decision indicating this incorrect PPO discount will be overturned when reviewed by IBR.

Recommended Supporting Documents

DaisyBill Resources

Webinar: Requests for Second Review

Webinar: Second Review Strategy Kit, Part I

Webinar: Second Review Strategy Kit, Part II

DaisyBill Solution

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.

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: