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Task: Denial Received - IBR

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

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

Expected: Official Medical Fee Schedule (OMFS) reimbursement amount due for the date of service of bill. 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 subtracted by Payment Total reimbursement. The Balance Due amount represents the remaining due if the bill is reimbursed at the OMFS reimbursement.

Step 2. To close the bill, Click ‘Close’

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


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