To be complete, a bill submission must meet certain requirements.
Frequently Asked Question
Q: Can I still collect payment for an incomplete bill?
A: A claims administrator can refuse to pay a bill if the bill is not complete as defined by the DWC. However, if a claims administrator determines that a bill is incomplete, it must return an EOR in 30 days which specifies what is incorrect. From there, you can correct the submission.
Complete bill submissions must consist 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.