ASK A QUESTION

What Constitutes a Complete Bill

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.

Explanation

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.  

Additional Information

Division of Workers’ Compensation Medical Billing and Payment Guide

DaisyBill Resources

Webinar: Overview of California Workers’ Compensation

REQUEST DEMO

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DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

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