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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 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 easy. Just click the Second Review button, select the Procedure Code(s) that require review, and click Submit.

To request a Second Review for a Denied Bill ($0 reimbursement), see Request for Second Review: Denied Bill.

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 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. 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.

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 add additional ‘Documents,’ click ‘Add,’ then upload the document(s)

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

Step 9. To submit the Second Review, click ‘Send’

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

If ‘Yes’ was selected for New Documents Attached in Step 5, the new documents are already selected for submission. If desired, select additional documents from Documents Previously Sent.

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

Your Second Review is on its way!

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