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
Reduction in accordance with _____ Contract.
This charge was adjusted to comply with the rate and rules of the contract indicated.
Second Review Reason (SBR-1 Form)
This bill payment was incorrectly discounted citing a “PPO Discount”.
Despite requesting proof of PPO contract, to date, no proof of PPO contract has been received.
This practice and provider do NOT have a PPO contract or agreement authorizing this payment discount. Accordingly, please review this bill for additional payment per OMFS.
Optional: Attached is a copy of an OVERTURN IBR Decision indicating this incorrect PPO discount will be overturned when reviewed by IBR.
Recommended Supporting Documents
- IBR Case Overturn for No PPO Discount
- Letter to claims administrator/contract administrator requesting proof of PPO contract
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.