The deadlines for submitting bills under automatic authorization are shorter — bills must be submitted within 30 days of treatment for non-emergency services, and within 180 days for emergency services — but untimely submission is NOT grounds for denial under the new regulations for automatic authorization.
When a standard bill is submitted after the 12-month deadline, payment is barred. However, no existing regulations bar payment for untimely submission of a bill for automatically authorized services.
When an original bill is incorrectly denied or underpaid, daisyBill advises filing a Second Review. 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.
To store language for Request for Second Review reasons in daisyBill, use the Second Review Reasons. When a bill receives an incorrect denial for automatically authorized services rendered due to untimely bill submission, we recommend using language similar to the Second Review reason in this article.
You may also download our sample SBR letter here.
Official Medical Fee Schedule
Any
CPT Code(s)
Any
Payable
Yes
EOR Denial Reason
Bill not submitted within 30 days of non-emergency treatment [automatic authorization only]
Bill not submitted within 180 days of emergency treatment [automatic authorization only]
Second Review
Reason for Requesting Second Bill Review
Service meets criteria for automatic authorization, including the 6 qualifying conditions for automatic authorization specified in Labor Code Section 4610. No existing regulations bar payment for automatically authorized treatment when the bill is untimely submitted.
Please immediately reprocess this bill and issue payment.