This Billing Guide outlines Arizona’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 Arizona.
Forms |
Services |
daisyBill Resources |
CMS-1500* |
Physician Services Pathology / Laboratory DME PT / OT Radiology |
|
UB-04* |
Facility |
|
No Form Specified |
Pharmacy |
|
No Form Specified |
Dental |
* Recommended but not required
State-Mandated Physician Reporting Requirement
This table is a guide to daisyBill's resources on the reporting forms required for compliant paper and electronic workers’ comp billing in Arizona.
Report |
Form |
Requirement |
daisyBill Resources |
Physician’s Initial Report of Injury |
Within 8 days of initial treatment |
||
Continuing Treatment Report |
None specified |
Every 30 days while continuing treatment |
|
Patient Discharge Report |
None specified |
Upon patient discharge |
Electronic Billing Mandate
The Arizona Industrial Commission 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.
Additional Bill Requirements
Arizona Revised Statute § 23-1062.01 requires any billing from a health care provider shall include each of the following:
- The correct demographic patient information and claim number, if known.
- The correct health care provider information, including name, address, telephone number and federal taxpayer identification number.
- The appropriate medical coding with dollar amounts and units clearly stated with all descriptions.
- Clearly printed date or dates of service.
- Legible medical reports required for each date of service if the billing is for direct treatment of the injured worker.
daisyBill Solution
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