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Denial Incorrect - Duplicate Bill

Summary

When a claims administrator non-compliantly processes your bill, the California Division of Workers’ Compensation (DWC) recommends that you file an Audit Complaint. Using your Audit Complaints, the DWC can intervene and correct a claims administrator’s improper bill processes.

Taking a few minutes to file an Audit Complaint potentially improves California workers’ comp billing for you and the entire workers’ comp community.

The DWC allows you to file an Audit Complaint confidentially, so reporting improper behavior poses no risk to your relationship with the claims administrator.

Reason for Audit Complaint

Bill Type:

Medical-Legal

Submission Type:

Original Bill

Complaint Category:

Incorrect Denial

Complaint Reason:

Original Bill incorrectly denied as duplicate bill submission.

Additional Complaint Information - Non-electronic Submission (Fax):

EOR incorrectly denies Original Bill as duplicate billing. The Original Bill and Supporting Documents were submitted via facsimile. As documented in the Bill History, the fax transmission is confirmed as received by claims administrator.

Additional Complaint Information - Electronic Submission:

Original Bill and Supporting Documents were submitted electronically. As documented in the Bill History, the claims administrator returned an accepted acknowledgement verifying receipt of Original Bill and Supporting Documents.

How to file an Audit Complaint

When a claims administrator incorrectly denies your Original Bill you should:

  1. Contact Claims Administrator (Optional)
  • Inform claims administrator that your Original Bill was complete and compliant, and included the required supporting documents.
  • Explain to the claims administrator that you have verifiable proof the claims administrator received the Original Bill with supporting documents.
  1. File Audit Complaint
  • Create Audit Complaint:

- DaisyBillers:

  • From Bill History, choose Denial Incorrect: Original Bill incorrectly denied as duplicate bill submission.
  • Additional Complaint Information noted above automatically populates the DWC Audit Referral Form.

- Non DaisyBillers: Link to DWC’s Audit Referral Form (link to Form Directions).

  • Additional Comments: Provide details of conversations and emails with claims administrator, if any.
  1. Submit a request for Second Review (Required for additional payment)
  • Within 90 days of receipt of the original EOR file a request for Second Review to dispute the incorrect reimbursement.

Additional Information

Division of Workers’ Compensation Medical Billing and Payment Guide

DaisyBill Resources

Blog Post: Audit Complaints – Making Things Right in Workers’ Comp

Webinar: Audit Complaints for Workers’ Compensation

DaisyBill Solution

With DaisyBill’s Revenue Cycle Management technology, it takes about 5 seconds to file an Audit Complaint.

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