Forms & Publications
- Health Care Services Forms
Select the link above and scroll down to Health Care Services Forms
Other Information
- Professional Review Policy
- Publication of Injured Worker's Social Security Number on the EOB
- Explanation of Benefits (EOB)
- Provider's Report of Claim & Request for Medical Payment Form
- Copying Fee Charges by Health Care Providers under a Subpoena
- Health Care Services Rule Requirement to Reimburse Providers a 3% Late Fee for Payments That Exceed 30 Days
