Need to appeal a partially paid bill? Submit a Second Review / Appeal!
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.
For California claims, submit a request for Second Review within 90 days of the Original EOR. A partially paid 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!
Don’t worry — DaisyBill makes Second Reviews / Appeals easy. The process is the same for both!
To request a Second Review / Appeal for a Denied Bill ($0 reimbursement), see Request for Second Review / Appeal: Denied Bill.
Step 1. From the the Bill Page, 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. Select the Procedure Code(s) requiring Second Review / Appeal
Check the box next to each incorrectly reimbursed Procedure Code.
Step 3. For each ‘Procedure Code’ enter ‘Reason for Requesting Second Bill Review’ / ‘Reason for Requesting Appeal’
The Reason for Requesting Second Bill Review / Appeal MUST directly address the denial reason provided in the Explanation of Review (EOR). For example Second Review / Appeal language, see these Help Articles.
Step 4. Optional: for authorized services, select ‘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 / Appeal, click ‘Edit’
Step 8. Optional: to add additional ‘Documents,’ click ‘Add Document’ then upload the document(s)
For more information, see the Help Article: Request for Second Review / Appeal: Add New Supporting Documents
Step 9. To submit the Second Review / Appeal, click ‘Send’
Step 10. Choose a Delivery Method, then click ‘Send’
Your Second Review / Appeal is on its way!