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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
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.
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.
Step 3. For Sufficient Payments, from ‘No Money Due’, click ‘Done’
Clicking Done moves the Bill to Done status.