Providers Request for Adjustment


Providers Request for Adjustment

Document Information
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Title	Providers Request for Adjustment (A fillable form - 381 KB PDF)
Description	Providers use this to report total overpayment, partial overpayment and/or underpayment by L&I. These forms will be accepted by L&I. They may not be accepted by all Medical Bill Processors due to lack of a barcode.
Detail
Form number	F245-183-000
Availability	Order it
Keywords	billing, billing errors, bills, medical, medical services, most requested forms, overpayment, provider, underpayment
Languages	English
Valid dates	10-2006
Contact information	Managing Injured Workers' Claims
Web pages	For Medical Providers