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 |
|
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. |
||
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 |
||
|
Request for Additional Medical Documentation for C-9 |
Upon request for additional medical documentation |
||
Medication Physician Review |
Optional |
||
Mental Health Notes Summary |
Optional |
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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