Second Review

Second Review Loopholes Hurt Providers
Mar 27, 2019
Second Review Loopholes Hurt Providers
Our previous articles highlighted claims administrators’ processing speed for original bill submissions. Now, we turn our attention to average days to process Second Review a...
📬 Payer Responses: Guile, Waiting, and Crickets  🏏
Mar 1, 2019
📬 Payer Responses: Guile, Waiting, and Crickets 🏏
Today we report on the responses from Sedgwick, Liberty Mutual, York, and State Compensation Insurance Fund (SCIF), following our posts detailing their systematic underpaymen...
Maximus Confirms Using Second Review Appeals to Correct Billing Errors
Feb 12, 2019
Maximus Confirms Using Second Review Appeals to Correct Billing Errors
Correcting a coding error is as simple as submitting a Second Review appeal explaining the error. Last year, we discussed the convoluted process to correct billing err...
No Response to Second Review Request?  A Lien Is the Only Option
Oct 10, 2018
No Response to Second Review Request? A Lien Is the Only Option
A recent refusal by Travelers Insurance to respond to a provider’s second review appeal, and subsequent denial of the provider’s request for Independent Bill Review (IBR), pe...
CA Providers: Do Not Alter Bill When Submitting Second Review Appeal
Sep 14, 2018
CA Providers: Do Not Alter Bill When Submitting Second Review Appeal
To appeal incorrect reimbursements or bill denials, California providers must submit timely and compliant requests for second review. To date, DaisyBill clients have recovere...
CA Providers: Appeal Denials for Treatment Preceding Liability Decision
Jun 27, 2018
CA Providers: Appeal Denials for Treatment Preceding Liability Decision
Recently, we pointed out that California employers are liable for treatment that precedes the claims administrator’s decision to accept or deny a workers’ comp claim. Before ...
Workers’ Comp Billing Error: Resubmit or Request Second Review Appeal?
May 30, 2018
Workers’ Comp Billing Error: Resubmit or Request Second Review Appeal?
Mistakes happen. When a provider accidentally submits an original bill that contains an error, taking the appropriate action is key to avoiding further delay in reimbu...
Data Reveals Importance of Second Review Appeal for Providers
May 25, 2018
Data Reveals Importance of Second Review Appeal for Providers
The claims administrator’s Bill Review does not always recommend the correct reimbursement on the first try. Our second review appeal data reveals a staggering amount of reve...
VPay Error Impacts Thousands of Sedgwick EORs
Feb 23, 2018
VPay Error Impacts Thousands of Sedgwick EORs
VPay, a payment processing company which issues explanation of reviews (EORs) and virtual credit card payments from claims administrators to providers, suffered a technical g...
How to Bill for Physician-Dispensed Pharmaceuticals
Feb 15, 2018
How to Bill for Physician-Dispensed Pharmaceuticals
Payments for physician-dispensed drugs are some of the most misunderstood — and incorrectly denied — in workers’ compensation billing. Too often, the employer or insurer’s cl...
Providers: Don't Accept 2017 OMFS Rates for 2018 Dates of Service
Feb 13, 2018
Providers: Don't Accept 2017 OMFS Rates for 2018 Dates of Service
Lately, we’ve noticed a problem. Some claims administrators are reimbursing providers incorrectly. Instead of paying the higher 2018 Official Medical Fee Schedule (OMFS), cla...
“Automatic” Authorization, but Denied Bill? How to Appeal the Denial
Feb 7, 2018
“Automatic” Authorization, but Denied Bill? How to Appeal the Denial
The new “automatic” authorization process for workers’ comp is in effect, as of January 1. We’ve discussed this new system extensively on our blog and in our recent webinar, ...