Providers Request For Second Bill Review {SBR-1}

DWC Form SBR-1 - PROVIDER’S REQUEST FOR SECOND BILL REVIEW. This form is used to initiate the second bill review process required by Labor Code sections 4603.2(e), for medical treatment services and goods, and by Labor Code section 4622, for medical-legal services, to dispute the amount of payment. The Division of Workers’ Compensation’s (DWC) regulation outlining the process can be found at California Code of Regulations, title 8 (8 C.C.R.), section 9792.5.5. Under this process, a medical provider who disputes the amount paid by a claims administrator on either a bill for medical treatment services or goods, or a bill for medical-legal expenses, must request a second review of the bill from the claims administrator. The second bill review process must be completed before a provider can seek independent bill review of a billing dispute. A request for second bill review must be made within 90 days of service of the explanation of review that explained why the payment you sought in the initial bill was reduced or denied. If an issue that would preclude your right to receive compensation for the submitted bill is under consideration by the Workers’ Compensation Appeal Board (WCAB), you have 90 days from the date of the service of the WCAB order that resolves the issue to request the second bill review. If the only dispute is the amount of payment and you do not timely request a second bill review, the bill will be considered satisfied and neither the claims administrator nor the employee shall be liable to you for any further payment. www.FormsWorkflow.com