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Texas Department of Insurance Division of Workers Compensation Medical Fee Dispute Resolution MS-48 7551 Metro Center Drive Suite 100 Austin Texas 78744-1645 518-804-4000 telephone 512-804-4811 fax www.
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How to fill out medical fee dispute resolution
How to fill out Medical Fee Dispute Resolution, MS-48
01
Gather all necessary documentation, including medical bills and any previous correspondence related to the dispute.
02
Obtain the Medical Fee Dispute Resolution (MS-48) form from the appropriate agency or website.
03
Fill out the MS-48 form completely, ensuring all required fields are filled in accurately.
04
Attach copies of supporting documents, such as medical records and proof of payment, to the MS-48 form.
05
Review the completed form and attached documents for accuracy and completeness.
06
Submit the MS-48 form and accompanying documents to the designated Medical Fee Dispute Resolution address.
07
Keep a copy of the submitted form and documents for your records.
08
Monitor the progress of your dispute resolution and respond promptly to any requests for additional information.
Who needs Medical Fee Dispute Resolution, MS-48?
01
Healthcare providers seeking reimbursement for services rendered but denied payment.
02
Patients who have received medical services and believe they have been charged incorrectly.
03
Insurers who need clarification on medical billing disputes.
04
Workers' compensation claimants involved in a dispute regarding medical fees.
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What does a dispute resolution specialist do?
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What is Medical Fee Dispute Resolution, MS-48?
Medical Fee Dispute Resolution, MS-48 is a process used to address disagreements between medical providers and insurers regarding the payment of medical fees for services rendered.
Who is required to file Medical Fee Dispute Resolution, MS-48?
Medical providers or healthcare facilities that believe they have not been compensated appropriately for services provided are typically required to file Medical Fee Dispute Resolution, MS-48.
How to fill out Medical Fee Dispute Resolution, MS-48?
To fill out Medical Fee Dispute Resolution, MS-48, providers must complete required sections including patient information, service details, disputed amounts, and any supporting documentation to substantiate their claim.
What is the purpose of Medical Fee Dispute Resolution, MS-48?
The purpose of Medical Fee Dispute Resolution, MS-48 is to provide a formal mechanism for resolving disputes over medical payment amounts, ensuring fair compensation for healthcare services.
What information must be reported on Medical Fee Dispute Resolution, MS-48?
The information that must be reported includes the provider's details, patient's details, the nature of the dispute, the dates of service, itemized billing information, and any relevant insurance claim numbers.
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