Electronic Billing Authorization

Electronic Billing Authorization - (Forms/Publications)
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Title Electronic Billing Authorization (A fillable form - 32 KB PDF)

To authorize L&I to accept electronically submitted bills for services provided to injured workers (2 pages).

Form number F248-031-000
Online only. See document above to download.
Keywords billing, bills, Direct Entry, provider
Languages English
Valid dates 12-2011
Contact information Fee Schedules
Web pages For Medical Providers

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