Choosing the Correct Form for a Work Comp Bill

When submitting a paper workers’ compensation bill, it’s critical to use the correct billing form.

Frequently Asked Question

Q: Which form should I use for workers’ comp bills?
Here’s the short answer: Most work comp bills submitted on paper should use the CMS 1500 form, while bills submitted electronically use electronic protocols to transmit the same information. However, the DWC uses four separate forms for billing on paper.


The DWC mandates the use of four different forms for billing on paper, depending on the service or goods provided:

  1. Form CMS-1500 for use by healthcare providers.
  2. Form CMS 1450 or UB-04 is the NUBC health insurance claim form for use by health facilities and institutional care providers as well as home health providers.
  3. The American Dental Association Dental Claim Form is for – you guessed it – dentists.
  4. The NCPDP Workers’ Compensation/Property & Casualty Claim Form is the claim form adopted by the National Council for Prescriptions Drug Programs, Inc. for pharmacy bills for workers’ compensation.

One more thing: Be sure to use the correct version of each form. As an example, the DWC recently switched to a different version of CMS 1500 and now requires the use of the updated form and updated instructions. This new form looks very much like the old form, so always check for the correct version number (02-12) on the bottom right corner:

Additional Information

Division of Workers’ Compensation Medical Billing and Payment Guide

DaisyBill Resources

Webinar: Overview of California Workers’ Compensation


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