REQUEST BY A HEALTH CARE PROVIDER FOR CASE STATUS INFORMATION TO FILE A MEDICAL FEE DISPUTE APPLICATION Forms
| Form Name | REQUEST BY A HEALTH CARE PROVIDER FOR CASE STATUS INFORMATION TO FILE A MEDICAL FEE DISPUTE APPLICATION |
| Form # | WC-194 |
| Form Revision | (01-23) |
| Category | Forms » Medical/Health |
| Downloads | |
| Form State | Missouri |
| Language | English |
| State Description | A form for use by health care provider to determine case status to file a medical fee dispute application. |
| Claimwire Description | n/a |