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Task: Denial Received

When a $0 reimbursement is posted to an Original Bill submission, DaisyBill automatically moves the Bill to Processed status, generates a Denial Received task. and assigns the task to a designated DaisyBiller.

To complete the Denial Received task determine whether additional funds remain due for the bill.

Watch Denial Received tasks closely. For incorrect reimbursements, timely completion of Denial Received tasks guarantees submission of Second Bill Reviews (SBRs) within the mandated 90-day timeline.

Here’s how it’s done.

Step 1. For each Procedure Code, compare the ‘Expected’ to the ‘Payment Total’

Expected: The Official Medical Fee Schedule (OMFS) reimbursement amount due for the bill’s date of service. The Expected amount includes fee-affecting workers’ comp billing ground rules (eg., surgical cascading, MPPR, NCCI, MUE) calculations. It does not include contracted or network discounts.

Payment Total: Total posted reimbursement amount allowed by claims administrator.

Expected %: Payment Total reimbursement divided by the Expected OMFS reimbursement.

Balance Due: Expected reimbursement minus Payment Total reimbursement. The Balance Due amount represents the remaining due if the bill is to be reimbursed at the OMFS reimbursement.

Step 2. For insufficient payments, choose an option from the ‘Action Bar’

Second Review: Changes Bill Status to Incomplete, navigates to the Second Bill Review (SBR) functionality. For more information, see the Help Article: Request for Second Review: Denied Bill.

Lien: Changes Bill Status to Lien, queues the bill with all other bills for the injury marked for Lien status. (But does not file a lien. This must be done outside DaisyBill.) For more information, see the Help Article: Mark Bill as Lien - Lien Filed.

Step 3. For sufficient payments, click ‘Close’

This moves the Bill to Closed status and completes the task.

Nice work!

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