APPLICATION FOR PAYMENT OF ADDITIONAL REIMBURSEMENT OF MEDICAL FEES Forms
| Form Name | APPLICATION FOR PAYMENT OF ADDITIONAL REIMBURSEMENT OF MEDICAL FEES |
| Form # | WC-MD-02 |
| Form Revision | (01/23) |
| Category | Forms » Financial/Compensation |
| Downloads | |
| Form State | Missouri |
| Language | English |
| State Description | A form for use by health care provider applying for payment of additional reimbursement of medical fees in a workers’ compensation medical fee dispute- if a partial payment has been made. (These are c |
| Claimwire Description | n/a |