For incorrectly denied or underpaid Original bills, DaisyBill advises filing a Second Review and including IBR decisions as supporting documentation.
Official Medical Fee Schedule
EOR Denial Reason
The billed service was not authorized by UR.
Second Review Reason (SBR-1 Form)
UR authorized all billed services. Please reprocess this bill and issue payment. Documented authorization submitted with original bill.
The authorization is included with this SBR-1 Form.
Optional: Attached is a copy of an OVERTURN IBR Decision indicating this incorrect denial will be overturned when reviewed by IBR.
Recommended Supporting Documents
- IBR Case Overturn of Denied for Authorization Example 1
- IBR Case Overturn of Denied for Authorization Example 2
- IBR Case Overturn of Denied for Authorization Example 3
- Copy of authorization for services
Webinar: Request for Second Review
Webinar: Second Review Strategy Kit, Part I
Webinar: Second Review Strategy Kit, Part II
Every request for Second Review submitted from DaisyBill is compliantly submitted using both a completed DWC Form SBR-1, as well as a compliant modified CMS 1500.