The Pennsylvania Workers' Compensation Board requires that health care providers file a medical report on Form LIBC-9 (PDF) within 10 days of treating an injured worker and at least once a month during treatment thereafter.

Required Documentation

Title 34. Part VIII. § 127.203 of the Rules and Regulations set forth in the PA Workers’ Compensation Act further specifies that the form prescribed by the Bureau shall require providers to supply the following documentation when applicable:

• information on the claimant's history, the diagnosis
• a description of the treatment and services rendered
• the physical findings and the prognosis

• including whether or not there has been recovery enabling the claimant to return to pre-injury work without limitations

NOTE: Insurers may request additional documentation to support medical bills submitted for payment by providers, as long as the additional documentation is relevant to the treatment for which payment is sought.

Additionally, § 127.203.b clarifies that physicians do not need to furnish a medical report in months wherein treatment is not rendered.

Report Form

The Pennsylvania Workers' Compensation Board lists Form LIBC-9 as the required form for any Worker’s Compensation Medical Report.

For additional information related to reporting please refer to daisyBill’s Pennsylvania Billing Guide.

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