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Billing Guide

Last update
June 28, 2019

This Billing Guide outlines Pennsylvania’s workers' compensation billing requirements and DaisyBill’s resources for filing compliant electronic and paper 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 Pennsylvania.

Forms

Services

DaisyBill Resources

CMS-1500 (HCFA)

Professional Services

CMS-1500 Instructions

UB-04

Facility

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 Pennsylvania.

Attachment Description

Days until Due

 Form

DaisyBill Resources

Workers’ Compensation

Medical Report Form

10 days after treating and at least once a month thereafter during treatment

LIBC-1

Medical Report Form Instructions

Electronic Billing Mandate

The Pennsylvania Department of Labor and Industry 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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