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Texas Department of Insurance Division of Workers Compensation Medical Fee Dispute Resolution, MS48 7551 Metro Center Drive, Suite 100 Austin, Texas 787441645 5128044000 telephone 5128044811 faxes

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How to fill out medical fee dispute resolution

01

Obtain a copy of the medical bill and any documentation related to the dispute.

02

Contact your insurance company or healthcare provider to discuss the dispute and attempt to resolve it directly.

03

If the dispute is not resolved, request a medical fee dispute resolution form from your insurance company.

04

Complete the form with detailed information about the dispute, including any supporting documentation.

05

Submit the form to the appropriate regulatory body or organization for review and resolution.

Who needs medical fee dispute resolution?

01

Anyone who believes they have been overcharged or incorrectly billed for medical services may need medical fee dispute resolution.

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What is medical fee dispute resolution?

Medical fee dispute resolution is the process of resolving disagreements between healthcare providers and insurance companies over the fees charged for medical services.

Who is required to file medical fee dispute resolution?

Healthcare providers or insurance companies may file a medical fee dispute resolution if they are unable to reach an agreement on the fees for medical services.

How to fill out medical fee dispute resolution?

To fill out a medical fee dispute resolution, the party filing the dispute must provide detailed information about the medical services provided, the fees charged, and any relevant documentation.

What is the purpose of medical fee dispute resolution?

The purpose of medical fee dispute resolution is to ensure that healthcare providers are fairly compensated for the services they provide, while also preventing overcharging by insurance companies.

What information must be reported on medical fee dispute resolution?

Information such as the date of service, description of medical services provided, fees charged, and any supporting documentation must be reported on a medical fee dispute resolution.

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