It’s official: daisyBill providers have recovered over $100 million in revenue by electronically submitting Second Review appeals to dispute incorrect reimbursements from California claims administrators.

This staggering reimbursement milestone highlights a critical fact about California workers’ compensation: Providers are routinely underpaid for treating injured workers — not exactly happy news for providers or the employers who pay premiums to ensure their workers’ care.

Instant Second Review appeals is one of the biggest benefits of daisyBill software. Here’s how our providers have reclaimed so much revenue with our technology:

1. The claims administrator sends the provider an electronic Explanation of Review (e-EOR) to daisyBill with payment information.
2. daisyBill automatically posts the e-EOR payment amount to the e-bill.
3. daisyBill analyzes the payment and alerts the practice to submit a Second Review appeal, if the payment is below the fee schedule amount.

Every time reimbursement is improperly withheld from providers who treat injured workers, it necessitates appeals, extra bill review, and other needless expenses — hardly what employers believe they’re paying for with their workers’ comp premiums.

Below, see how a single practice recovers an average of over $1 million every year, just by clicking the ‘Second Review’ button.

Second Review Appeals Sent Electronically

In California, to dispute an incorrect reimbursement or denial, providers have 90 days from receipt of the claims administrator’s EOR to submit a compliant Second Review appeal; California regulations require the provider to submit the Second Review appeal electronically if the original bill was submitted electronically.

For daisyBill clients, when the payment amount or denial reason listed on the EOR is incorrect, electronically submitting a Second Review requires 3 simple steps:

1. Select the improperly paid procedure code(s).
2. Complete the ‘Reason for Requesting Second Bill Review and Description of Supporting Documentation’ portion of the required SBR-1 form (daisyBill includes a handy Second Review Reason “Library” that can automatically populate this portion of the form).
3. Click ‘Save’ and ‘Send.’

That’s it! Compared to manually comparing EORs to bills and filling out the entire SBR-1, requesting Second Review electronically is a time-saving snap.

Practice Recovers Average $1 Million+ Annually

One California practice put up especially impressive Second Review collections, demonstrating just how critical these Second Reviews are to managing and protecting revenue for workers’ comp treatment.

This practice has used daisyBill since 2015. By submitting Second Review appeals, the practice has recovered a total of over $10 million dollars in improperly withheld reimbursements.

While the necessity of chasing claims administrators down for reimbursement owed is regrettable, the above is a testament to the power of e-billing technology — and proof that such technology is indispensable to making workers’ comp financially sustainable for practices.

Protect your practice revenue. Harness the power of daisyBill software, data, and expertise for faster, better workers’ comp billing.

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