Medical billing resources

Appropriate billing forms:
CMS 1500
UB 04 - hospital
ADA - dental
NCPDP - pharmacy

Chart notes or documentation to support services provided

The employer's workers' compensation insurer for the injured worker

If you do not have the insurer's address, or know who the insurer is for an employer, you can submit a request online or call WCD Employer Index at 503-947-7814.

Medical Fee Dispute Request

When a dispute about fees exists between a provider and an insurer, a provider, insurer, or injured worker may request review by the director. A request for review must be submitted to the director within 90 days of the date the aggrieved party knew or should have known that the dispute existed.

Use these forms to request review:
Medical Fee Dispute Resolution Request (Form 2842)
Medical Fee Dispute Resolution Worksheet (Form 2842a)