APPLICATION FOR DIRECT PAYMENT Forms
| Form Name | APPLICATION FOR DIRECT PAYMENT |
| Form # | WC-MD-01 |
| Form Revision | (01-23) |
| Category | Forms » Financial/Compensation |
| Downloads | |
| Form State | Missouri |
| Language | English |
| State Description | A form for use by a health care provider to apply for direct payment in regards to a workers compensation medical fee dispute.If the health care provider believes that it shows that it was authorized. |
| Claimwire Description | n/a |