Claims administrators have 14 days to process a Second Review submission. When a reimbursement is not posted to the Second Review submission within the mandated timeframes (45 days for Original Bills and Second Review Bills, 60 days for Medical Legal Bills), daisyBill automatically assigns a No Response - Second Review task to the designated user.
This indicates untimely bill processing by the Claims Administrator, and interest / penalties may be due. For Second Bill Reviews, the timeframe is 45 days.
Note: The No Response - Second Review task is specific to California workers’ compensation bills.
This video has more information about the No Response task.
To complete this task, contact the claims administrator to determine payment status.
Here’s how it’s done.
Step 1. From the Bill Page, click ‘Claims Administrator Profile,’ then contact the Claims Administrator and obtain payment status
In most circumstances, calling Bill Review is the most efficient way to determine the status of the bill payment.
Step 2. To record payment status, click ‘Report Status’
2a. If the bill is processed, select ‘Bill Processed’ and enter call details
Select this option if the claims administrator indicated the bill was processed and the Explanation of Review was sent. This completes the No Response task and generates an EOR Missing task to remind the appropriate user to locate and post the EOR.
2b. If the bill is not on file, select ‘Bill Not On File’
Select this option if the claims administrator indicated the bill was not received. This completes the No Response task.
Then do either of the following:
- Report the Error. It is important to let the daisyBill compliance team know that there may be a problem with this claims administrator. For more information, see the Help Article: Report Error. If necessary, daisyBill will resubmit the bill for you at no charge.
- Resubmit the bill by clicking Send on the Action Bar. For the resubmitted Second Review, box 10d on the CMS 1500 will contain BGW3, the notation for a Second Review submission.
2c. If the bill is on file but pending finalization, select ‘Bill In Process’
Select this option if the claims administrator acknowledged receipt of the bill, but no EOR has been issued to date. This completes the No Response task.
If a reimbursement is not posted within 15 days, a new No Response task automatically generates and is assigned to the designated user.
2d. If voicemail was left, select ‘Left Message Requesting Status’
Select this option if a phone call was made but bill status was not obtained. Selecting Left Message Requesting Status does not complete the No Response task but it does allow the user to set a follow-up date for the task.
Use the Update No Response Task Due Date field to select a new due date for the task as a reminder to follow-up.
You’re on your way to getting this bill resolved!