WC Second Review
Incorrect Reimbursement: PPO / Network
Reduction Incorrectly Applied This bill payment was incorrectly discounted [__%] with the EOR citing a “PPO Discount”. Attached is a letter dated [DATE] asking for proof of the PPO contract cited in the EOR. To date, no proof of PPO contract has been provided. This practice and provider do NOT have a PPO contract or agreement authorizing this payment discount. Accordingly, please review this bill for additional payment per OMFS. Attached is a copy of an OVERTURN IBR Decision indicating this incorrect PPO discount will be overturned when reviewed by IBR. Labor Codes
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SAMPLE LETTER
IBR INSTRUCTIONS
FORM IBR_1
FORM SBR_1
Second Review guidelines
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