independent bill review: 5 requirements ibr appeal... · mail california division of workers'...

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© DaisyBill 2017 Workers’ Compensation Resources 1. Injury accepted by claims administrator 2. Only reimbursement amount disputed as required by a. OMFS b. 5307.11 contracts (including, PPO contracts) 3. Timely request for Second Review a. Within 90 days of receipt of original EOR 4. Claims administrator issued a Second Review EOR 5. Timely IBR submission a. Within 30 days of receipt of Second Review EOR $ Independent Bill Review: 5 Requirements

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Page 1: Independent Bill Review: 5 Requirements IBR Appeal... · MAIL California Division of Workers' Compensation Electronic Medical Billing and Payment Companion Guide Version I .2 12 Months

© DaisyBill 2017 Workers’ Compensation Resources

1. Injury accepted by claims administrator 2. Only reimbursement amount disputed as required by

a. OMFSb. 5307.11 contracts (including, PPO contracts)

3. Timely request for Second Reviewa. Within 90 days of receipt of original EOR

4. Claims administrator issued a Second Review EOR5. Timely IBR submission

a. Within 30 days of receipt of Second Review EOR

$

Independent Bill Review: 5 Requirements