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, or click ‘Send Duplicate’ to resubmit the bill without contacting the claims administrator.
Here’s how it’s done.
Step 1. From the Bill Page, click ‘Contact Claims Administrator’
In most circumstances, calling Bill Review is the most efficient way to determine the status of the bill payment.
Step 2. Contact the Claims Administrator with the provided contact information to obtain bill payment status.
3. Report the Bill Payment Status with one of the five provided options.
3a. If a voicemail was left, select ‘Message Left Requesting Bill Payment Status’
Select this option if a phone call was made but bill status was not obtained. Enter all the details of your call in the fields to the right. 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.
3b. If the bill is on file but pending finalization, select ‘Explanation of Review (EOR) Pending’
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.
3c. If the bill is processed, select ‘Explanation of Review (EOR) Sent’ 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.
3d. 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. The bill will be automatically reported to the daisyBill compliance team for investigation. If necessary, DaisyBill will resubmit the bill for you at no charge.
3f. If the bill is was forwarded to another payer for payment, select ‘Bill Forwarded to Different Payer’
Select this option if the claims administrator indicated the bill was received and then forwarded to another payer for finalization.
4. Click ‘Save’ after you have selected the appropriate response
You’re on your way to getting this bill resolved!