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Second Review: Denied as Duplicate
When a Second Review is incorrectly denied by a claims administrator as a Duplicate Billing, contact the claims administrator and/or file an Audit Complaint.
If your Second Review is falsely denied, and the reason for the denial is listed as “duplicate billing,” follow DaisyBill’s recommended steps below.
Additional Payment Recommendations
To recoup the additional money due when a Second Review is incorrectly denied as a duplicate bill, follow these instructions:
- Contact the claims administrator and request that they reprocess the Second Review.
- If payment is not received within 30 days of the date of the Final EOR denying the Second Review as a duplicate bill, file an application for Independent Bill Review within 30 days of receipt of the EOR denying the Second Review as a duplicate bill.
File Audit Complaint
For Second Reviews incorrectly denied as duplicate bills, immediately file an Audit Complaint with the DWC. Follow these directions to file the audit complaint using DaisyBill 5 Second Audit Compliant. In order for the DWC to take action against noncompliant claims administrators, providers must alert the DWC by filing audit complaints.
At DaisyBill, we find Incorrect Denials incredibly frustrating. These unjustified denials indicate either:
- Claims administrators are not paying attention to the bills they receive, so it doesn’t matter whether providers submit complete and timely bills and Second Reviews, or
- The claims administrators are incorrectly denying bills with the intent of creating even more friction to prevent providers from receiving payment for services rendered to injured workers.
Either way, the providers end up paying in money, time, and resources when trying to get paid. Simply put, it’s bad business, and every provider must take action and file an Audit Complaint when their bills are incorrectly denied.