Step 1 — Spot the reduction
When a payer underpays a medical-legal bill, Mindbill flags it at the top of the bill detail page. The banner reads the dollars below the Medical-Legal Fee Schedule and the percentage paid — here, $2,033 below MLFS, 60% of MLFS paid, tagged PPO/MPN reduction — illegal on med-legal. It explains that CCR §9789.30(d) bars PPO/MPN reductions on MLFS reimbursement and estimates the recoverable amount ($1,260 at the 62% historical SR collection rate). An SR in flight · 14-day clock indicator tracks the response window.
Step 2 — Confirm the reduction line by line
Scroll to the EOR — Explanation of Review and procedure-code table to verify exactly what was reduced. Each line shows billed vs paid vs balance with a percentage: in this example ML201 was paid at 60% ($1,814 of $3,022.50 billed) and the MLPRR record-review line at just 33% ($412 of $1,236). Confirming the per-line math is how you build an SBR the payer can't wave away — the dispute amount is the sum of those balances, $2,032.50.
Step 3 — Generate the SBR-1 with the §9789.30(d) rebuttal
Click Second Review. Mindbill auto-selects the playbook from the EOR's adjustment code — here the saved reason PPO/MPN reduction not allowed on med-legal — and pre-fills the DWC SBR-1 form with the line-by-line dispute and the total in dispute ($2,032.50). It generates a rebuttal citing CCR §9789.30(d) and attaches the controlling Maximus IBR precedent that overturned the identical PPO reduction. Review the language, then dispatch: the SBR-1 is filed via the same clearinghouse and saved to the bill's documents (DWC_Form_SBR-1.pdf).
Step 4 — Mind the 90-day rule and escalate to IBR if needed
File exactly one SBR per EOR, within 90 calendar days of receipt — never file a second SBR on the same EOR. The payer then has 30 days to respond. If the SBR is denied or upheld, escalate to Independent Bill Review within 30 days using the IBR generator (/wizard/ibr-application); the $180 filing fee is recovered from the claims administrator when Maximus rules in your favor. For a clean §9789.30(d) PPO dispute, the precedent is settled law.
