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Request for Second Review: Denied Bill

Need to Second Review a denied bill?

Second Reviews must be submitted within 90 days of the Original EOR. A partially paid bill not contested within 90 days of original processing is deemed satisfied and neither the claims administrator nor the employee is liable for further payment.

But don’t worry -- DaisyBill makes appealing incorrect reimbursements as easy. Just click the Second Review button, select the service line items that require review, and submit.

To request a Second Review for a partially paid bill, see Request for Second Review: Partial Payment. Read on for help with Second Reviews for incorrectly denied bills.

Step 1. With the Bill in ‘Processed’ status, go to the Bill Page, and click ‘Second Review’

In order to submit a Second Review, 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 ‘Second Review All Service Line Items’

Check this box to request a Second Review of all service line items on the denied bill.

Step 3. Select or Add a Reason for Requesting Second Bill Review

The information provided in the Reason for Requesting Second Bill Review automatically populates all service line items on the denied bill. Select a listed reason or choose a Custom Phrase. For more information, see the Help Article: Apply Second Review Reasons.

The Reason for Requesting Second Bill Review must directly address the denial reason provided in explanation of review (EOR). For example Second Review language see the Help Article: Second Review Example Language.

Step 4. For Authorized Services, click ‘Yes’ under ‘Authorized?’

No selection leaves this non-required field blank on the DWC Form SBR-1.

Step 5. Optional: if attaching new Supporting Documentation, click ‘Yes’ under ‘Supporting Documentation Attached?’

Each Second Review submitted through DaisyBill includes the following documents:

  • DWC Form SBR-1
  • Modified CMS-1500 (with paper EOR if uploaded)
  • Coversheet with Final EOR due date

If attaching new additional Supporting Documents (not previously submitted with the Bill), check the Yes box.

No selection leaves this non-required field blank on the DWC Form SBR-1.

Step 6. Click ‘Save’

Step 7. To edit the Second Review, click ‘Edit Second Bill Review’

Step 8. Optional: to edit individual line items, uncheck ‘Second Review All Line Items’

Steps 3-5 are copied to each line item. Make individual changes to line items if necessary.

Step 9. Add any additional ‘Supporting Documents’, then click ‘Submit’

For more information, see the Help Article: Request for Second Review: Add New Supporting Documents

Step 10. From the pop-up window, ‘Choose Second Review Documents’ to submit

The pop-up window displays a list of all Supporting Documents attached to Bill. If Yes was checked for Supporting Documents Attached in Step 5, the new documents are already selected for submission. If desired, select additional documents to transmit from Supporting Documents Previously Submitted.

Step 12. Choose a Bill Submission Method, then click ‘Submit’

Remember, Via DaisyBill is always the fastest, most reliable method.

You’re all set!

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