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Task: Payment Received
When manual or electronic reimbursement is posted to a bill, DaisyBill automatically moves the Bill to Processed status, generates a Payment Received task and assigns the task to a designated user.
This means the payer adjudicated (processed) the original bill, and payment was issued.
So what’s next? Determine if additional funds are due.
Watch Payment Received tasks closely. For incorrect reimbursements, timely completion of Payment Received tasks guarantees submission of Second Bill Reviews (SBRs) within the 90-day mandated timeline.
Here’s how to follow up on Payment Received tasks.
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. The ‘Expected’ amount includes fee-affecting workers’ comp billing ground rules (e.g., 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. For more information, see the Help Article: Request for Second Review: Partial Payment.
Lien: Changes Bill Status to ‘Lien’, queues the bill with all other bills for the injury marked for ‘Lien’ status. For more information, see the Help Article: Mark Bill as Lien - Lien Filed.
Step 3. For sufficient payments, click ‘Done’
This moves the bill to Done status.
Note that Review Bill Payment tasks appear in the Bill History: