The workers’ comp community has now had time to work its way through a substantial number of Second Bill Reviews (SBRs). Unfortunately, we here at DaisyBill find that some claims administrators struggle to adhere to the mandated requirements for SBRs (see title 8, California Code of Regulations sections 9792.5.4 – 9792.5.6 for rules relating to second review of medical bills).

One example from the electronic billing world is the inability of some claims administrators to accept and process electronic SBRs.

Broadspire is a claims administrator that is usually pretty good about following workers’ comp billing rules as promulgated by California’s DWC.  However, Broadspire can’t comply with the requirement that all claims administrators must be able to accept electronic SBRs when the original bill was submitted electronically.

Broadspire incorrectly denies compliant electronic SBRs as duplicates.  When DaisyBill contacted Broadspire about the incorrect denials, a Broadspire representative acknowledged that these SBRs were being incorrectly processed and offered a fax number as an alternative.

DaisyBill is now programmed to fax Broadspires SBRs--270 faxes and counting.  

The electronic billing rules, as well as the rules for second bill reviews, have been in place for almost two years.  Many smaller TPAs and insurers can process electronic SBRs, so we’re not sure why Broadspire can’t, especially as it’s otherwise generally compliant.  We can’t help wondering whether there’s a technology deficiency at Broadspire or if Broadspire, on behalf of employers that choose Broadspire, simply choosing not to comply with the DWC rules and regulations?