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This document outlines the findings and decision regarding a medical fee dispute between a requestor and an insurance carrier concerning reimbursement of services rendered under the Texas Workers’
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How to fill out medical fee dispute resolution

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How to fill out Medical Fee Dispute Resolution, MS-48

01
Gather all necessary documents related to the medical fee dispute, including bills and payment records.
02
Obtain a copy of the Medical Fee Dispute Resolution, MS-48 form from the appropriate authority or website.
03
Fill out the claimant's information accurately, including name, address, and contact details.
04
Provide detailed information about the medical services received, including dates, provider details, and service descriptions.
05
Clearly state the amount disputed and the reason for the dispute.
06
Attach all supporting documents, such as explanations of benefits (EOBs) and invoices, to your completed form.
07
Review the completed form for accuracy and completeness before submission.
08
Submit the MS-48 form and all attachments to the specified address or online portal as directed.

Who needs Medical Fee Dispute Resolution, MS-48?

01
Any individual or organization dissatisfied with a medical bill or payment determination made by an insurance company.
02
Healthcare providers seeking resolution on unpaid or underpaid claims.
03
Patients who believe they have been overcharged for medical services received.
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Medical Fee Dispute Resolution, MS-48 is a process established to resolve disputes regarding medical fees charged for services rendered to injured employees under workers' compensation.
Any party involved in a dispute over medical fees, including healthcare providers and workers' compensation insurance carriers, is required to file Medical Fee Dispute Resolution, MS-48.
To fill out Medical Fee Dispute Resolution, MS-48, the filer must complete all required sections, including information about the healthcare provider, the injured employee, the insurance carrier, and details of the disputed charges, and then submit it to the appropriate authority.
The purpose of Medical Fee Dispute Resolution, MS-48 is to provide a structured mechanism for resolving disputes over medical billing in workers' compensation cases, ensuring that appropriate fees are paid for services provided.
The information that must be reported includes the details of the medical services rendered, the billed amount, the amount deemed appropriate by the payer, reasons for the dispute, and the parties involved in the dispute.
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