Second Review

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

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

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 ...

Work Comp Billing Error: Resubmit or Request Second Review?

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 Reveal 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 reveal a staggering amount of reven...

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

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

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

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, ...

How It Works: Independent Bill Review (IBR)

Think about what workers' comp providers go through to obtain correct payment for treating injured workers. Compliant authorization and billing are taxing enough. Appealing i...

The Parity Problem: How Work Comp Favors Insurers Over Providers

In disputes over payment in the California workers’ compensation system, insurers have an unfair advantage over providers. At every stage of the billing process, the b...

The Provider’s Burden: Appealing Improper Reimbursements

Workers’ comp billing is hard enough. Four years ago, California passed strict requirements that providers must follow to appeal incorrect reimbursements from insurers...