C4 Forms and
Workers' Compensation Billing
C4 forms are required when
billing for medical services related to
workers' compensation when a patient was injured on the
job. Workers compensation insurance will pay for all sorts of medical benefits.
Many practice management systems come with these forms as a standard
insurance form listed in the insurance form menu of the program. That is
the easiest way to submit them. You actually print the claim on white
paper, and the program not only prints up the charges and other
information, but actually creates the form too.
If your practice management
system does not have
the form available, you can usually get a blank form online
through your state's website. Some companies also sell blank forms.
Once you have a blank form,
you can either type the information in, or if your software has the
capabilities, you can program your software to fill in the boxes on the
form.
In any case, you
will need to submit a copy directly to the workers' compensation carrier,
and the state workers' compensation board as well. The board needs a copy of every workers
comp claim filed. Mileage for the injured patient is calculated from
the comp boards records.
Some of the information
contained on the C4form is:
- Patient's demographics
- Workers' comp carrier
name & id #'s, including WCB #
- Employer information
- Location, Date &
Description of how injury occurred
- Information on
evidence of pre-existing condition
- Patient's current
working status
- If patient is disabled
from regular duties
- Is disability total or
partial
- Is injury going to
result in permanent restriction
- Information on
treatment being rendered
- Diagnosis, date of
service, procedures, and charges
- Provider's billing
information
It is extremely important that
all boxes on the C4form are completed accurately. The information on
these forms is used during any hearings for the injured party. If the information is not
completed, or is not accurate, it can adversely affect the
outcome of the hearing.
Coming
soon! Detailed instructions on completing a C4 Form
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Return to Claim forms
from C4 Forms
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