Independent Bill Review (IBR)
Medical treatment and medical-legal billing disputes are 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.
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 Services 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 $195.00
- 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
All IBR decisions since the program began on Jan. 1, 2013 are posted on DWC’s website after being issued. IBR cases withdrawn or determined to be ineligible are not posted. The DWC IBR search tool allows users to easily research the database of IBR case decisions.
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.
- IBR Maximus contract - Jan. 1, 2015 - Dec. 31, 2017 extended through Dec. 31, 2019
- Maximus presentations
- Medical Billing and Payment Guide - Oct. 2015
- Medical Billing and Payment Guide - Feb 2014
- Medical Billing and Payment Guide - Jan. 2013
- Electronic Medical Billing and Payment Companion Guide - Feb. 2014
- Electronic Medical Billing and Payment Companion Guide - Jan. 2013
|For additional questions or assistance, please contact Maximus at:|
|Toll free: 1-855-865-8873
Fax: (916) 605-4280
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