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Billing Guide

Last update
November 13, 2023

This Billing Guide outlines Washington’s workers' compensation billing requirements and daisyBill’s resources for filing compliant electronic and paper bills.

Billing Form Requirements

This table is a guide to daisyBill's resources on the required forms for compliant paper and electronic workers’ comp billing in Washington.

Forms

Services

daisyBill Resources

CMS-1500 (HCFA)

Physicians, Osteopaths, Advanced Registered Nurse Practitioners, Chiropractors, Naturopaths, Podiatrists, Psychologists, and Registered Physical Therapists;

Inpatient – Hospitals

CMS-1500 Instructions

UB-04

Outpatient – Hospitals

NCPDP

Pharmacy

Statement for Pharmacy Services (PDF)

ADA

Dental

Statement for Miscellaneous Services (PDF)

State-Mandated Physician Reporting Requirements

This table is a guide to daisyBill's resources on the reporting forms required for compliant paper and electronic workers’ comp billing in Washington.

Attachment Description

Number of Days until Due

 Form Link

Provider's Initial Report (PIR)

Within 5 days of initial visit

Provider's Initial Report (PIR)

Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease

Within 5 days of initial visit

Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease

Electronic Billing Mandate

The Washington State Department of Labor & Industry has not issued electronic billing regulations or rules for medical bills. Accordingly, contact the payer to determine if workers’ comp bills can be submitted electronically.

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