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Billing Guide

Last update
July 2, 2019

This Billing Guide outlines Ohio’s workers' compensation billing requirements and DaisyBill’s resources on how to file 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 Ohio.

Forms

Services

DaisyBill Resources

CMS-1500 (HCFA)

Physician Services

CMS-1500 Instructions

UB-04

Facility

Not Specified

Pharmacy

ADA

Dental

C-19

Other Services

State-Mandated Physician Reporting Requirements

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

Attachment Description

Due

 Form Link

DaisyBill Resources

Physician’s Report of Work Ability

Upon every claimant encounter, unless the claimant has been awarded compensation for permanent total disability; returned to work without restrictions within seven days of the injury; or has been released to return to employment without restrictions.

MEDCO-14 (PDF)

Physician’s Report of Work Ability Instructions

Physician's Request for Medical Service or Recommendation for Additional Conditions for Industrial Injury or Occupational Disease

Upon request for information or to request authorization for additional treatment

C-9 (PDF)

Request for Additional

Medical Documentation for C-9

Upon request for additional medical documentation

C-9-A (PDF)

Medication Physician Review

Optional

MEDCO 22

Mental Health Notes Summary

Optional

MEDCO 16

Electronic Billing Mandate

The Ohio Bureau of Workers' Compensation 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.

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