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Billing Guide

Last update
May 30, 2019

This Billing Guide outlines Indiana’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 Indiana.

Forms

Services

DaisyBill Resources

CMS-1500

Physician Services

Pathology / Laboratory

CMS-1500 Instructions

UB-04

Facility

Not Specified

Pharmacy

Not Specified

Dental

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 Indiana.

Attachment Description

Number of Days until Due

 Form Link

Physician’s Report

Not Specified

Physician's Report State Form 2118

Electronic Billing Mandate

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

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