Independent Bill Review (IBR)
Medical treatment and medical-legal billing disputes will now be resolved through an independent bill review (IBR) process. A medical provider who disagrees with the amount paid by a claims administrator on a properly documented bill may apply for IBR. IBR applies to any medical service bill where the date of service is on or after Jan. 1, 2013 and where the fee is determined by a fee schedule established by the DWC.
Application process
A medical provider who disputes payment for medical service or medical-legal billing must submit a timely request to the claims administrator for a second review of the bill. If the provider disagrees with the outcome of the second review, they may request IBR within 30 days after service of the second review decision.
To request IBR, the medical provider must submit an application for IBR either electronically or in hard copy. An application for IBR can be completed and submitted electronically by registering as a user on the Maximus Federal IBR tracking system.
If submitting in hard copy, the following information should be included:
- Completed application for independent bill review
- A check or money order for IBR fee of $335.00
- Any required and/or supporting documentation
Mail the above information to:
DWC - IBR
c/o Maximus Federal Services, Inc.
PO BOX 138006
Sacramento, CA 95813-8006
A medical provider can request that separate medical billing disputes be consolidated as part of IBR. Separate requests for IBR must be submitted as part of the initial IBR request and must meet criteria specified in the IBR regulations.
Resources
IMR and IBR communications with Maximus- Request for Independent Bill Review form
- Provider’s Request for Second Bill Review form
- Medical Billing and Payment Guide
- Electronic Medical Billing and Payment Companion Guide
- Frequently asked questions about independent bill review
- IBR emergency regulations
Contact Maximus
| For those interested in becoming an IBR reviewer, please contact Maximus at: |
| Richard Weiss, MD, MPH, MMM, PMP Project Director 625 Coolidge Drive, Suite 150 Folsom, CA 95630 Office: (916) 673-4401 Fax: (916) 605-4270 Email: RichardCWeiss@maximus.com |
| For additional questions or assistance, please contact Maximus at: |
| Toll free: 1-855-865-8873 Fax: (916) 605-4270 Email: IBRhelp@maximus.com |
Contact DWC Medical Unit
| For other questions related to the IBR process not addressed above, please contact the DWC Medical Unit: |
| DWC - Medical Unit Independent Bill Review P.O. Box 71010 Oakland, CA 94612 Toll free: 1-800-794-6900 Phone: (510) 286-3700 Email: DWC@dir.ca.gov |
What's New
May 2013