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Billing & Reimbursement Topics

Health care providers participating in the Florida workers' compensation health care delivery system are required to be familiar with the reimbursement policies related to billing and reporting of medical care and treatment pursuant to Chapters 69L-7 and 69L-8, F.A.C. Each of the following links provide information essential to the timely and proper reporting and reimbursement of services rendered by health care providers eligible to receive reimbursement for authorized services.

Reimbursement Manuals

Click on the links below to select the current reimbursement manual in effect for your provider type.

Billing Forms

Click on the links below to select the correct medical billing form which is incorporated into Chapter 69L-7, F.A.C.

Form DFS-F5-DWC-9/CMS-1500Health Insurance Claim Form, Rev. 02/2012
Form DFS-F5-DWC-10Statement of Charges for Drugs and Medical Equipment & Supplies Form, Rev. 01/01/2015
Form DFS-F5-DWC-11American Dental Association Dental Claim Form
Form DFS-F5-DWC-90/UB-04 CMS-1450Uniform Bill, Rev. 11/03/2006

Click on this link for the current medical billing form completion instructions for all provider types.
Click on this link for the current Uniform Medical Treatment/Status Report Form and form completion instructions.