For incorrectly denied or underpaid Original bills, DaisyBill advises filing a Second Review and including IBR decisions as supporting documentation.
Official Medical Fee Schedule
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)
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
- IBR Case Overturn of Incorrect PPO Discount
- Copy of pertinent page(s) of applicable contract
Webinar: Request for Second Review
Webinar: Second Review Strategy Kit, Part I
Webinar: Second Review Strategy Kit, Part II
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.