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-1500, Health Insurance Claim Form, Rev. 02/12
- Form DFS-F5-DWC-10, Statement of Charges for Drugs and Medical Equipment & Supplies Form, Rev. 01/01/2015
- Form DFS-F5-DWC-11, American Dental Association Dental Claim Form
- Form DFS-F5-DWC-90/UB-04 CMS-1450, Uniform Bill, Rev. 11/03/2006
Billing Form Completion Instructions - Click on this link for the current medical billing form completion instructions for all provider types.
Reporting Form DFS-F5-DWC-25 - Click on this link for the current Uniform Medical Treatment/Status Report Form and form completion instructions.