Required Medical Bill Treatment and Diagnosis Information

Medical providers receive expeditious processing of medical bills by submitting their bills with the following information:

• Description of accident or occupational disease  
• Detailed description of injury
• Is the injury casually related?
• Details of prior injuries, diseases or physical impairment, including prescription drug history
• Date of your first treatment
• Current diagnosis, prognosis and anticipated treatment plan; advise if treatment is continuing, and include the next scheduled treatment date
• Include ICD 9 (International Classification of Diseases, 9th Revision) code for each diagnosis
• Provide results of diagnostic tests rendered
• Provide medical necessity for any treatment, diagnostic test(s) or surgery, for Medical Authorization Requests
• Provide first day (“date”) injured worker was unable to perform work due to his/her impairment
• Provide injured worker's current work status
• Advise if patient is able to perform regular duties; If no, tell us why
• Include any work restrictions as well as the degree of disability: total, marked, moderate or mild
• Advise if patient can perform any type of work; If yes, describe work capacity