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Billing Guide

Last update
December 23, 2022

This Billing Guide outlines Maine’s workers' compensation billing requirements and daisyBill’s resources on how to file compliant medical bills.

Billing Form Requirements

This index is a guide to daisyBill's resources on the required forms for compliant paper and electronic workers’ comp billing in Maine.

Forms

Services

daisyBill Resources

CMS-1500

Physician Services

Laboratory / Pathology

Facility – Outpatient

DME

Dispensed Pharmaceuticals

CMS-1500 Instructions

UB-04

Facility – Inpatient

Not Specified

Pharmacy

Not Specified

Dental

State-Mandated Physician Reporting Requirements

For a Complete Bill, Maine 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

 Form (PDF)

Initial Evaluation

Medical Report

5 days from evaluation

M-1 DIAGNOSTIC MEDICAL REPORT

Interim Evaluation

Medical Report

Every 30 days

Final

Medical Report

5 days from evaluation

Upon Request

Medical Report

10 days from request

Electronic Billing Mandate

The Maine Workers’ Compensation Board does not regulate electronic billing for medical bills. Accordingly, contact the payer to determine if workers’ comp bills can be submitted electronically.

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