FYI: Inaccurate DWC IBR Form May Cost Your Practice

FYI: Inaccurate DWC IBR Form May Cost Your Practice

California’s Division of Workers’ Compensation (DWC) has strict and specific requirements for providers who wish to dispute incorrect payment amounts through Independent Bill Review (IBR). If the provider fails to take any of the mandated steps timely or correctly, the dispute is automatically considered resolved and the provider forfeits reimbursement.

But apparently, the DWC does not hold itself to the rigorous standards to which it holds providers.

DWC Form IBR-1, which providers must use when requesting IBR, contains misinformation that may cause providers to lose their chance at securing correct reimbursement. Specifically, the form incorrectly directs providers to mail their IBR submission to an address that no longer accepts mail.

Providers have reported to daisyBill that they mailed their IBR form and the mandated documents to the address listed on the IBR form, but subsequently the IBR was returned as undeliverable.

Given the amount of time it can take for a snail-mailed packet of documents to arrive at the wrong location and eventually make its way back to the provider, this may mean that providers miss the 30-day deadline to request IBR.

Why hasn’t DWC Form IBR-1 been updated to reflect this months-old change — or any of the changes that have occurred since the current version of the form debuted?

DWC Form IBR-1: Bad Mailing Instructions

As shown below, the DWC Form IBR-1 — which has not been updated since 2014 — currently instructs providers to mail IBR request submissions to an address in Folsom, California.

This Folsom address is no longer correct.

The Folsom address has not accepted mail since at least July of this year. Regardless, even the instructions that come with DWC Form IBR-1 (below) are very clear in directing doctors to send their submission to the wrong place — on penalty of considering the IBR request to be “not filed.”

…and just for bonus points, the instructions list an IBR filing fee of $335, which has been inaccurate since 2014 (the fee is currently $180).

In fact, the IBR filing fee has been updated several times since the current version of the IBR-1 became the required form for all providers requesting IBR. When it comes to accuracy in paperwork, the DWC clearly takes a “Do as I say, not as I do” approach.

The correct address to submit IBR requests is listed on the DWC’s IBR web page (shown below), updated most recently in August. The correct address is:

c/o Maximus Federal Services, Inc.
PO Box 138006
Sacramento, California 95813-8006

We urge the DWC to take ownership of its inexplicable delay in updating the forms that the DWC requires providers to use. California Labor Code Section 4603.6 mandates that providers have only 30 days from receipt of the final Explanation of Review (EOR) from the claims administrator to request IBR. Otherwise:

If the provider fails to request an independent bill review within 30 days, the bill shall be deemed satisfied, and neither the employer nor the employee shall be liable for any further payment.”

For providers who miss the deadline to file for IBR by reason of sending their IBR requests to the incorrect Folsom address, the DWC should grant an extension.

Given the DWC’s willingness to bend the rules in favor of claims administrators (and itself), and its laissez-faire approach to its own required paperwork, this snafu warrants bending the rules for providers for once.

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