Need to Second Review / Appeal a denied bill?
Depending on the State selected for the Injury, the Action Bar will display the option to either Second Review or Appeal. If California is selected as the Injury State, the option to Second Review will display. For all other states, the option to Appeal will display instead.
In California, Second Reviews must be submitted within 90 days of the Original EOR. A bill not compliantly contested within 90 days of original processing is deemed satisfied. Neither the claims administrator nor the employee is liable for further payment.
But don’t worry — daisyBill makes Second Reviews / Appeals easy. The process is the same for both!
To request a Second Review / Appeal for a partially paid bill, see Request for Second Review / Appeal: Partial Payment. Read on for help with Second Reviews / Appeals for incorrectly denied bills.
Step 1. With the Bill in ‘Processed’ status, go to the Bill Page, then click ‘Second Review’ / ‘Appeal’
In order to submit a Second Review / Appeal, a bill must be in Processed status. If the bill is not in Processed status, manually post the reimbursement amount to the original bill. For more help, see the Help Article: Post: Paper EOR.
Step 2. Check the box next to ‘Procedure Code’
Check this box to request a Second Review / Appeal of all service line items on the denied bill.
Step 3. Select or enter a ‘Reason for Requesting Second Bill Review’ / ‘Reason for Requesting Appeal’
The information provided in the Reason for Requesting Second Bill Review / Appeal automatically populates to all service line items on the denied bill. Select a listed reason or enter a Second Review / Appeal Reason. For more information, see the Help Article: Apply Second Review / Appeal Reasons.
The Reason for Requesting Second Bill Review / Appeal must directly address the denial reason provided in explanation of review (EOR). For example Second Review / Appeal language see the Help Article: Second Review / Appeal Example Language.
Step 4. For Authorized Services, click ‘Yes’ under ‘Authorized?’
If no selection is made, this non-required field is left blank on the DWC Form SBR-1 / Appeal Letter.
Step 5. Optional: if attaching new Supporting Documentation, select ‘Yes’ under ‘New Documents Attached’
Each Second Review / Appeal submitted through daisyBill includes the following documents:
- DWC Form SBR-1 / Appeal Letter
- Modified CMS-1500
- Paper EOR (if uploaded)
- daisyBill Cover sheet with Final EOR due date
If no selection is made, this non-required field is left blank on the DWC Form SBR-1 / Appeal Letter.
Step 6. Click ‘Save’
Step 7. To edit the Second Review, click ‘Edit Second Bill Review’ / ‘Edit Appeal’
Step 8. Optional: to edit individual line items, uncheck the box next to ‘Procedure Code’
Steps 3-5 are copied to each line item. Make individual changes to line items if necessary.
Step 9. Add any additional ‘Documents’, if needed
For more information, see the Help Article: Request for Second Review / Appeal: Add New Supporting Documents
Step 10. Click ‘Send’
Step 11. Choose a Delivery Method, then click ‘Send’
Remember, daisyBill’s Verified Route is always the fastest, most reliable method.
You’re all set!