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 fill out the form below and attach the bill.

Patient's Name
Patient's date of birth