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Task: Denial Received

When a $0 reimbursement is posted to an Original Bill submission either electronically or manually, 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, you must determine whether additional funds remain due for the bill.

For incorrect reimbursements, timely completion of Denial Received tasks guarantees timely 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 ‘Total Allowed’

Expected: Official Medical Fee Schedule (OMFS) is the 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.

Total Allowed: Posted reimbursement amount allowed by claims administrator.

% OMFS Allowed: ‘Total Allowed’ reimbursement divided by the ‘Expected’ OMFS reimbursement.

Balance: Expected is the reimbursement subtracted by Total Allowed reimbursement. The ‘Balance’ amount represents the remaining due if the bill is reimbursed at the OMFS reimbursement.

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Step 2. For insufficient payments, choose an option from ‘More Money Due’

Second Review: Changes Bill Status to Incomplete, navigates to the Second Bill Review (SBR) functionality.

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.)

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Step 3. For sufficient payments, choose ‘No Money Due’, then click ‘Done’

Clicking Done moves the Bill to Done Status.

Nice work!

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