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Task: Denial Received - Second Review

When a $0 reimbursement is posted to a Second Review submission either electronically or manually, DaisyBill automatically moves the Bill to Processed status, generates a Denial Received - Second Review task and assigns the task to a designated DaisyBiller.

  • Indicates the payer adjudicated (processed) the Second Review Bill
  • No payment was issued

DaisyBill Workflow: PROCESSED Status → Denial Received - SBR Task

Completing Task

To complete the task, a user must determine whether additional funds remain due for the bill by deciding if more money due.

  • For incorrect reimbursements, timely completion of Denial Received - Second Review tasks guarantees timely submission of Independent Bill Review (IBR) within the 30-day mandated timeline.

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

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.

Total Allowed: Posted reimbursement amount allowed by claims administrator.

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

Balance: ‘Expected’ 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 to create an additional SBR submission.

Lien →  Changes Bill Status to Lien, queues the bill with all other bills for the injury marked for ‘Lien’ status.

IBR → Changes Bill Status to Incomplete, navigates to the Independent Bill Review (IBR) functionality to create an IBR submission.  For more, see the Help Article: Create IBR Submission.

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Step 3. For Sufficient Payments, from ‘No Money Due’, click ‘Done’

Clicking Done moves the Bill to Done status.

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Simple!

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