Second Review (SBR) is the first and mandatory step for disputing the amount a payer paid on a California workers'-comp bill. Mindbill makes filing nearly automatic, but you should understand what's happening under the hood — when an SBR is the right remedy, the deadline you cannot miss, and what the payer's response means. This explainer covers the decision, the 90-day rule, the in-app flow, and the three outcomes.
File a Second Review whenever the payer reduced your billed amount and you disagree on the AMOUNT: a PPO/MPN discount on a medical-legal bill (illegal under CCR §9789.30(d)), a CO-50 denial of a covered service, or a CO-97 bundling of distinct services. Do NOT file an SBR for things that aren't amount disputes: patient eligibility issues (fix and rebill), a missing attestation like CO-16 on MLPRR (fix and rebill — no SR required), or any case where your original bill had a genuine error. Filing an SBR on the wrong category just burns your one shot.
You get exactly one Second Review per EOR, and it must be filed within 90 calendar days of receiving that EOR. Miss the window and the A/R is legally deemed satisfied — the money is gone. Never file a second SBR on the same EOR; that's non-compliant. Mindbill auto-flags bills approaching the deadline so a recoverable underpayment never quietly ages out of its appeal window.
The flow is five clicks: (1) open the bill detail page; (2) click File Second Review; (3) Mindbill auto-selects the playbook from the EOR's CAS code(s) — pre-loading the §9789.30(d) rebuttal for a PPO reduction, for instance; (4) review the auto-generated SBR-1 letter, which you can edit before send; (5) click Submit SR. The SBR is filed via the same clearinghouse the original bill used and saved to the bill's documents. Most payers acknowledge within 3–5 business days.
The payer then has 30 days to respond, with three possible outcomes. Overturned (about 62% of Mindbill SBRs): payment issued, typically within 14 days. Upheld: escalate to Independent Bill Review if the dispute is procedural, or concede if it's genuinely substantive. Partial: the payer restores part of the reduction, and you decide whether to IBR the remainder. If the payer doesn't respond at all within 30 days, that silence is itself actionable.
Two escalation paths follow a Second Review. If the SBR is denied or upheld on a fee-schedule dispute, file an Independent Bill Review within 30 days — the $180 filing fee is recovered from the claims administrator when Maximus rules in your favor, and a clean §9789.30(d) PPO dispute is settled law. If instead the payer simply never responds (no EOR at all, or no SBR response), escalate through the audit-complaint wizard under LC §4622, which carries the self-executing medical-legal penalty (10% penalty + 7% interest after the 60-day deadline).
A 15-minute demo on your workflow — bill entry, second review, and reporting. No slides.