APPLICATION FOR ADMINISTRATIVE RULING Forms
| Form Name | APPLICATION FOR ADMINISTRATIVE RULING |
| Form # | WC-214 |
| Form Revision | (01-23) |
| Category | Forms » Legal/Fraud |
| Downloads | |
| Form State | Missouri |
| Language | English |
| State Description | A form which may be completed by a health care provider, an employer or insurer in a “reasonableness” medical fee dispute where the amount in dispute does not exceed $1000. |
| Claimwire Description | n/a |