There are 3 types of bills accepted by the Ohio Bureau of Workers’ Compensation for services provided to injured workers. The C-19 is a service invoice specific to BWC. The UB-92 and HCFA-1500 are national standard billing forms that you can order by calling the American Medical Association at 1-800-621-8335.

BWC’s medical billing system that classifies bills as either facility or non-facility bills. Facility bills are related to hospital-based services and are submitted on the UB-92 form. Non-facility bills are related to services from all other providers and are submitted on either the HCFA-1500 or BWC’s C-19 form.

All parties to a claim may view basic medical billing information through our Web site. Once you reach the claim inquiry screen, you must enter a valid claim number and select the bill inquiry function. If you are not a party to the claim, you cannot view information specific to the claim.

The following information is displayed on each bill:

• Servicing provider name — the name of the individual physician who performed the service or treatment;
• Pay to provider name – the name of the provider to whom the medical payment is made;
• Invoice number — a specific number assigned to identify an individual bill;
• Date of service — the date the injured worker receives treatment;
• Funds release date — the date BWC releases funds either to a provider or to a Managed Care Organization (MCO);
• Bill status — the end result or present status of a specific submitted medical bill (ex. paid, denied, in process);
• Billed amount — the sum of all charges on a medical bill submitted by the providers. This amount should be the sum of the entire bill;
• Amount allowed — the sum of the procedure charges after BWC has applied its reimbursement policies;
• Remit number — the number identifying the detailed list of medical bills that have been paid and denied to a medical provider. This list accompanies the check sent to the medical provider;
• EFT number — a payment number given to each electronic funds transfer (EFT). An EFT is an electronic method of distributing funds on the same basis as a direct deposit. BWC uses this eight-digit number for tracking purposes and to respond to inquires by MCOs;
• MCO name – the title identifying a particular MCO;
• MCO number — a five-digit number that identifies a particular MCO;
• MCO phone number —MCOs have toll-free telephone numbers.