This Billing Guide outlines Florida’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 Florida.
Forms |
Services |
DaisyBill Resources |
Form DFS-F5-DWC-9-A (CMS-1500 for Physicians) |
Physician Services Pathology / Laboratory |
|
UB-04 |
Facility – Outpatient Facility – Inpatient |
|
NCPDP |
Pharmacy |
|
ADA |
Dental |
|
Form DFS-F5-DWC-10 |
Statement of Charges for Drugs and Medical Equipment & Supplies Form |
State-Mandated Physician Reporting Requirements
For a complete bill, Florida requires providers to submit supporting documentation with a bill for services. The following table lists the types of attachments that may accompany a bill to fulfill this supporting documentation requirements.
Service |
Attachment Description |
Number of Days until Due after Date of Service |
Form Link (PDF) |
Initial Evaluation |
Florida Workers’ Compensation Universal Medical Treatment/Status Reporting Form |
3 business days from initial evaluation |
|
Subsequent Evaluations |
Florida Workers’ Compensation Universal Medical Treatment/Status Reporting Form |
Next business day following evaluation or 30 days from the previous submission |
|
Transfer of care |
Florida Workers’ Compensation Universal Medical Treatment/Status Reporting Form |
Next business day following evaluation or 30 days from the previous submission |
Electronic Billing Mandate
The Florida is a provider optional e-billing state; the Division of Workers’ Compensation has issued electronic billing regulations for medical bills. This means that healthcare providers in the state have the option of filing either electronic bills or paper forms.
DaisyBill Solution
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