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Request for Second Review: Partial Payment
Need to appeal a partially paid bill? Submit a Second Review!
Submit a request for Second Review 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 second reviewing incorrect reimbursements easy. Just click the Second Review button, select the Service Line Items that require review, and click Submit.
To request a Second Review for a Denied Bill ($0 reimbursement), see Request for Second Review: Denied Bill. Read on for how to request a Second Review for partially paid bills.
Step 1. From the the Bill Page, 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. Select the Procedure Code(s) requiring Second Review
Check the SBR? box next to each incorrectly reimbursed procedure code.
Step 3. For each ‘Procedure Code’ enter ‘Reason for Requesting Second Bill Review’
The Reason for Requesting Second Bill Review MUST directly address the denial reason provided in the Explanation of Review (EOR). For example Second Review language, see these Help Articles.
Step 4. For authorized services, click ‘Yes’ Under ‘Authorized?’
This field isn’t required. If you don’t make a selection, it will be 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 7. Optional: to add additional ‘Supporting Documents’, click ‘Add’, then upload the document(s)
For more information, see the Help Article: Request for Second Review: Add New Supporting Documents
Step 8. To submit the Second Review, click ‘Submit’
Step 9. Optional: from the pop-up modal, ‘Choose Second Review Documents to Submit’ choose ‘Supporting Documents’ to be sent with Second Review
If ‘Yes’ was checked for Supporting Documents Attached in Step 5, the new documents are already selected for submission. If desired, select additional documents from Supporting Documents Previously Submitted.
Step 10. Choose the Bill Submission Method, then click Submit
Your Second Review is on its way!