Claims Administrator Rectifies SBR Error

Claims Administrator Rectifies SBR Error

Pacific Claims Management responded to our August blog regarding misinformation about requests for Second Bill Review. DaisyBill spoke with a Pacific representative, with whom we also discussed concerns regarding changes to Pacific’s processing of electronic bills. Happily, not only did Pacific rectify both issues, they displayed a level of transparency and responsiveness that does the claims administrator credit.

We believe that Pacific’s willingness to engage in discussions like these ultimately benefits Pacific, the providers that send bills, and the workers’ comp system as a whole.

In August, a Pacific representative gave a DaisyBill client inaccurate information on how to dispute reimbursement. The provider followed Pacific’s erroneous advice, and Pacific subsequently denied the appeal. Since the Second Review was non-compliant, the provider could not request Independent Bill Review (IBR).

This week, Pacific Claims Management made amends. Their representative acknowledged the error, a misapplication of NCPDP directions for the CMS 1500. Pacific also assured DaisyBill that they will direct providers to dispute reimbursements by submitting Second Reviews using the proper DWC Form SBR-1. Pacific pledged to quickly and compliantly process those appeals. Pacific also resolved concerns regarding their method for accepting e-bills.

Always Submit Compliant Second Reviews

For providers, the importance of correctly appealing incorrect reimbursements cannot be overstated. Even with correct original billing, claims administrators make mistakes. A system for quickly and compliantly requesting Second Review is the provider’s first and best defense against inevitable improper reimbursements.

DaisyBIll clients have successfully collected over $21,000,000 by submitting over 300,000 Second Reviews. We carefully follow Labor Code § 4603.2 and California Code of Regulations § 9792.5.5 which lay out the instructions for submitting Second Reviews. Remember:

  • Requests for Second Review must be filed within 90 days of receipt of the Explanation of Review (EOR)
  • Submit requests for Second Review using the DWC Form SBR-1 , or a compliantly modified Original Bill.
  • For electronic original bills, requests for Second Review must be submitted electronically via modified original bill. While not required, we recommend also submitting a DWC Form SBR-1 as well with the modified bill.

Pacific Claims Management stood apart in their forthright willingness to address provider and DaisyBill concerns. DaisyBill submits over a million bills annually in California. It is truly great when a claims administrator works with us to improve how workers’ comp works for providers. We commend Pacific on their extraordinary response.

It’s nothing short of exemplary, and the entire field would be less problematic if others followed suit. Kudos to Pacific Claims Management.

DaisyBill offers everything providers need to ensure quick, compliant SBRs. To date, DaisyBill clients have submitted over 300,000 SBRs, collectively recovering over $21 million initially denied to them by claims administrators. Schedule a free demonstration, and see how much DaisyBill can save your office.


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