Non-Payment Complaint

Non-Payment Complaint Process

A non-payment issue arises when an accurately completed medical bill, which contains all the information required for the processing of payment, is submitted to a Workers' Compensation (WC) insurer for authorized medical treatment and/or service(s) and the WC insurer does not:

• Issue an Explanation of Bill Review (EOBR) in response to the health care provider’s medical bill and pay reimbursement for the billed services that are not denied or disallowed within 45 days following the submission of the medical bill; or
• Issue a rejection of the bill within 21 days of receipt, per rule 69L-7.602(5)(j)5., F.A.C.

Prior to filing a non-payment complaint with the Office of Medical Services, a health care provider (HCP) must re-submit the unpaid medical bill(s) via a verifiable delivery method (e.g. email, fax, certified mail or courier service) to document the carrier's receipt of the unpaid bill(s). If the carrier does not adjudicate the resubmitted bill within 120 days of the verifiable delivery date, the health carrier may elect to file a Non-Payment complaint with the Office of Medical Services.
The Non-payment Complaint shall be in writing and shall clearly provide the following information specific to the claim file:

• Carrier/ adjuster name, telephone number(s) and WC claim number;
• Injured employee's name, SSN , date of injury; and
• Health Care Provider patient account/claim number, date(s) of service addressed in complaint and billed amount(s).

The non-payment complaint must be accompanied by the following documentation for each bill for which the HCP has not received reimbursement or an EOBR:

• A legible copy of the accurately completed medical bill;
• An itemized Billing Statement (hospital services only);
• An accurately completed DFS-F5-DWC-25 for each date of service (physician encounter);

The Office of Medical Services will issue its finding no later than 30 days from receipt of all relevant information/documentation regarding the carrier’s liability for the unpaid bill.
Please direct questions regarding this process to WCMedBillNonpay@myfloridacfo.com

• Proof of submission or mailing of the medical bill to the insurer, e.g. fax transmittal, email, courier or USPS postal tracking number; and
• A call log or any communication between the health care provider and the carrier regarding payment of the outstanding charges for medical service(s) or treatment.

Non-Payment complaints may be filed with the Office of Medical Services via:

• Email at WCMedBillNonpay@myfloridacfo.com;
• Fax at 850.413.1982 ; or
• USPS at DWC-Office of Medical Services, 200 East Gaines Street, Tallahassee, FL 32399

The Office of Medical Services will issue its finding no later than 30 days from receipt of all relevant information/documentation regarding the carrier’s liability for the unpaid bill.

Please direct questions regarding this process to
WCMedBillNonpay@myfloridacfo.com