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Billing Guide

This Billing Guide outlines Arizona’s workers' compensation billing requirements and DaisyBill’s resources for filing compliant medical 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 Arizona.

Forms

Services

DaisyBill Resources

CMS-1500*

Physician Services

Pathology / Laboratory

DME

PT / OT

Radiology

CMS-1500 Instructions

UB-04*

Facility

No Form Specified

Pharmacy

No Form Specified

Dental

* Recommended but not required

State-Mandated Physician Reporting Requirement

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

Report

Form

Requirement

DaisyBill Resources

Physician’s Initial Report of Injury

Form 102

Within 8 days of initial treatment

Initial Report of Injury Instructions

Continuing Treatment Report

None specified

Every 30 days while continuing treatment

Continuing Treatment Report Instructions

Patient Discharge Report

None specified

Upon patient discharge

Patient Discharge Report Instructions

Electronic Billing Mandate

The Arizona Industrial Commission 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.

Additional Bill Requirements

Arizona Revised Statute § 23-1062.01 requires any billing from a health care provider shall include each of the following:

  1. The correct demographic patient information and claim number, if known.
  2. The correct health care provider information, including name, address, telephone number and federal taxpayer identification number.
  3. The appropriate medical coding with dollar amounts and units clearly stated with all descriptions.
  4. Clearly printed date or dates of service.
  5. Legible medical reports required for each date of service if the billing is for direct treatment of the injured worker.

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