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Create IBR Submission
When reimbursement remains due on a bill after Second Review, file for Independent Bill Review (IBR).
Per CCR § 9792.5.7, “If the provider further contests the amount of payment made by the claims administrator on a bill for medical treatment services or goods...the provider shall request an independent bill review.”
Step 1. Click ‘IBR’
For the IBR option to appear, the Bill must have been sent for Second Review and a Second Review EOR must have been received and posted.
Step 2. Select ‘Provider Type’
Step 3. Check ‘Contract for Reimbursement Rates?’ if Bill was processed according to a contract and upload ‘Relevant Contract Provisions’
- If no contractual discount was taken on Bill, do not check box.
- If the Bill was processed according to a network, contractual, or PPO discount check this box, even if the dispute is not about the discount.
- If Contract for Reimbursement Rates is checked, the Relevant Contract Provisions are required to be uploaded. Only the pages of the contract that summarize the reimbursement should be uploaded. Click Choose File to upload the Relevant Contract Provisions.
Step 4. Indicate if ‘Billed Service Authorized’
Step 5. Select Service Line Items to IBR
Step 6. Enter ‘Reach for Disputing Reduction or Denial of Full Payment’
This should be a concise explanation for why additional reimbursement is due on this bill. Cite labor codes and billing regulations where appropriate. The text in this field is printed directly onto the IBR-1 form.
Step 7. Enter ‘Claims Administrator Address’
A copy of the IBR must be concurrently served on the claims administrator. Enter the address for the claims administrator or adjuster where the IBR should be sent.
Step 8. Click Create
Step 9. Click ‘Cloud’ icon next to each payment and upload paper EOR
EORs are required to create IBR submission.
Step 9. Click ‘Submit’
Step 10. Click ‘Download’ to create IBR Submission
Step 11. Print IBR Submission packet and follow included directions page for submission
You’re all set!