C4 Forms - What Are They And When Do You Use Them?

Health Insurance Claim Form 1500 - C4 Forms - What Are They And When Do You Use Them?

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A C4 Form is a workers' payment board form titled "Attending Doctor's Report," that requests data about claimaint/claim identification, claim parties of interest, injury history, diagnosis, treatment, disability, causal relation of emergency to disability, and degree of impairment. The form is to be filed by the doctor within 15 days of the initial treatment, with added reports while treatment, and a final description at the completion of treatment. Once the initial form is filed, subsequent visits should be billed out within 45 days of the visit.

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Health Insurance Claim Form 1500

C4 forms are required when billing for services associated to workers' compensation, or when a patient was injured on the job. Many institution administration systems come with these forms as a approved guarnatee form listed in the guarnatee form menu of the program. That is the easiest way to submit them. You certainly print the claim on white paper, and the schedule not only prints up the charges and other information, but certainly creates the form too.
If your institution administration ideas does not have the form available, you can usually get a blank form online through your state's website.

Once you have a blank form, you can whether type the data in, or if your software has the capabilities, you can schedule your software to fill in the boxes on the form. In any case, you will need to submit a copy directly to the workers' payment carrier, and the state workers' payment board as well.

It is highly foremost that all boxes on the C4 form are completed accurately. A copy of the form is submitted to the state workers' payment board and those forms are usually scanned into a computer system. When or if a case goes to a hearing, the data on these forms is used. If the data is not completed, or is not accurate, it can adversely work on the outcome of the hearing. For example, if the doctor does not unblemished the box indicating the patient is disabled, and the patient is truly disabled, the employers lawyers can argue that the disability has not been established. So even leaving a field blank can be detrimental.

The forms are fairly easy to fill out and are pretty self explanatory.

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