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 mandated 90-day timeline.
Here’s how to follow up on Payment Received tasks.
Step 1. For each Procedure Code, compare the ‘Expected’ amount to the ‘Payment Total’
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.
Payment Total: Total posted reimbursement amount allowed by claims administrator.
Expected %: Payment Total reimbursement divided by the Expected OMFS reimbursement.
Balance Due: Expected reimbursement minus Payment Total reimbursement. The Balance Due amount represents the remainder due if the bill is to be reimbursed at the OMFS reimbursement.
Step 2. For insufficient payments, choose an option from the ‘Action Bar’
Second Review: Changes Bill Status to Incomplete, navigates to the Second Bill Review (SBR) function. 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. (But does not file a lien. This must be done outside DaisyBill.) For more information, see the Help Article: Mark Bill as Lien - Lien Filed.
Step 3. For sufficient payments, click ‘Close’
This moves the Bill to Closed status and completes the task.
Note that Payment Received tasks appear in the Bill History: