REQUEST FOR AWARD ON UNDISPUTED FACTS IN REGARD TO APPLICATION FOR DIRECT PAYMENT Forms
| Form Name | REQUEST FOR AWARD ON UNDISPUTED FACTS IN REGARD TO APPLICATION FOR DIRECT PAYMENT |
| Form # | WC-201 |
| Form Revision | (01-23) |
| Category | Forms » Legal/Fraud |
| Downloads | |
| Form State | Missouri |
| Language | English |
| State Description | A request by an employer or insurer for an award on undisputed facts in regard to an application for direct payment medical fee dispute. |
| Claimwire Description | n/a |