Workers' Compensation Medical Bill Submission
To better serve you, we are accepting medical bill submissions on behalf of providers via our secure portal. To ensure prompt payment, please complete the mandatory fields and upload a PDF copy of the bill on the UB or HCFA-1500 forms with supporting medical documentation. Incomplete submissions will not go through the bill review process, however you may be contacted for additional information.
Please complete the form below and upload a single document containing both medical records and bills.
Important: Please note that the website does not support multiple file upload and records and bills MUST be combined and uploaded in a single document.