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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 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 easy.

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, then 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 the box next to ‘Procedure Code’

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

Step 3. Select or enter a ‘Reason for Requesting Second Bill Review’

The information provided in the Reason for Requesting Second Bill Review automatically populates to all service line items on the denied bill. Select a listed reason or enter a Second Review Reason. 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?’

If no selection is made, this non-required field is left blank on the DWC Form SBR-1.

Step 5. Optional: if attaching new Supporting Documentation, select ‘Yes’ under ‘New Documents Attached’

Each Second Review submitted through DaisyBill includes the following documents:

  • DWC Form SBR-1
  • 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.

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 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’, then click ‘Send’

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

Step 10. From the pop-up window, select Second Review Documents to submit with the Second Review

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

Step 11. Choose a Delivery Method, then click ‘Send’

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

You’re all set!

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