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Billing Guide

Last update
May 23, 2019

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

CMS-1500 Instructions

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

DFS-F5-WC-25

Subsequent Evaluations

Florida Workers’ Compensation Universal Medical Treatment/Status Reporting Form

Next business day following evaluation or 30 days from the previous submission

DFS-F5-WC-25

Transfer of care

Florida Workers’ Compensation Universal Medical Treatment/Status Reporting Form

Next business day following evaluation or 30 days from the previous submission

DFS-F5-WC-25

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.

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