Submit bills to the appropriate managed care organization (MCO);
Submit bills according to formats specified by BWC;
Use the BWC-issued, 11-digit provider number in box 25 on the
CMS-1500 or box 11 on the C-19;
Use the BWC-issued, 11-digit group or pay-to provider number in box 33 of the
CMS-1500 or box 14 on the C-19;
Indicate the diagnosis code in box 24E or the diagnosis reference number in box
21 on the CMS-1500. For the C-19, refer to box 19 for all line items of the bill,
regardless of the provider type;
Indicate the two-digit, place-of-service code in box 24B on the CMS-1500 or
box 16 on the C-19;
Follow form completion guidelines in the Provider Billing and Reimbursement Manual (BRM);
Attempt to resolve outstanding billing issues with the appropriate MCO.
Don't …
Submit bills with the First Report of Injury (FROI);
Balance bill the injured worker or ask for co-payment;
Request payment from the injured worker for reimbursable covered services;
