Intellect™
SAMPLE - INDEPENDENT BILL REVIEW FORM
Effective version 16.02.22, Intellect can print a Worker's Compensation Independent Bill Review (IBR) form for submission to an independent company to request money in addition to that paid by the insurance company. A form is generated if:
• IBR is entered in the <Message> field on the Payment --►Open Item screen
• Independent Bill Review is selected at the bottom of the Payment --►Open Item screen
Intellect fills-in the fields shown below on the sample Independent Bill Review form.
Note: The 'Reason for Disputing Reduction or Denial of Full Payment' field in the Consolidation section may be filled either by manually writing in the information on the printed form, or IBR may entered in the <Message Code> field of Utility --►Messages --►Message with the appropriate reason typed into the main part of the screen.
