To be complete, a bill submission must meet certain requirements set forth by the California Division of Workers’ Compensation (DWC).

Definition of a Complete Bill

Per the California DWC Medical and Billing Payment Guide, complete bill submissions must include all of the following:

1. The correct form (if submitted on paper), or the correct format (if submitted electronically).
2. The correct UBC codes for the appropriate OMFS, including the correct ICD code.
3. Fields filled out according to the requirements for each format, as specified in Appendix A of the most recent CA DWC Medical Billing and Payment Guide and/or the Companion Guide to the same. See this article for more information on how to correctly fill out workers’ comp bills.
4. Required reports and supporting documentation.

Incomplete Bills Denied

A claims administrator may refuse to pay a bill if the bill is incomplete as defined by the DWC.  However, if a claims administrator determines that a bill is incomplete, it must return an Explanation Of Review (EOR) within 30 days which specifies any missing or invalid information.

Additional Information

Division of Workers’ Compensation Medical Billing and Payment Guide

DaisyBill Resources

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