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Denial Incorrect: Missing Documentation

Last update
June 23, 2022

When an original bill is incorrectly denied or underpaid, daisyBill advises filing a Second Review. 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.

To store language for Request for Second Review reasons, use daisyBill’s Second Review Reasons.

Denial Incorrect: Missing Documentation

Official Medical Fee Schedule


CPT Code(s)




EOR Denial Reason

We cannot review this service without necessary documentation. Please resubmit with recommended documentation as soon as possible.

Second Review

Reason for Requesting Second Bill Review

Re-submission of requested documentation. EOR incorrectly states supporting documents were not received with the Original Bill. The electronic transmission of the Original Bill conformed to the DWC's Electronic Companion Guide. Further, the claims administrator returned an accepted acknowledgement verifying receipt of Original Bill and Supporting Documents.

Recommended Supporting Documents

Relevant Regulation

Other Second Review Topics

Good luck!

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