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Workers’ Compensation Board

WCB Information Related To Novel Coronavirus (COVID-19)

Overview/Features


Please Note: It is anticipated that all versions of the C-4 medical billing forms (except the C-4.3) and the OT/PT-4 will be replaced by the required XML submission of the CMS-1500 form on July 1, 2021. Learn more about the CMS-1500 Initiative.

Health Care Providers submitting any versions of the C-4 forms (C-4, C-4.2, C-4.3, EC-4AMR, EC-4NARR) or OT/PT-4 form, must be authorized by the Board to treat workers' compensation injuries.

Apply for Authorization

For a list of forms which may be submitted online, please refer to the "List of Available Forms".

A user ID and password is required to submit these online forms. This is the same user ID and password used to access the Board’s Medical Portal.

Request User ID

If you submit a form online, DO NOT mail a duplicate paper form to the Board.


Features

Save Form Data

The Load Previously Saved Data and Save Data buttons, allow data from the form to be saved on your computer. You can then use the saved data to pre-populate fields the next time you submit the form. This may significantly reduce the amount of duplicate data entry required.

Attach a Document

You can attach documents to be submitted with the form.

Confirmation of Submission to the Board

After the Board receives your form, a non-editable PDF version of the form will appear in your web browser. The first page contains a confirmation that your form was successfully submitted to the Board and the date. This PDF should be saved for your records and used to send copies of the form and any attachments to required parties. DO NOT MAIL THIS FORM TO THE BOARD.

Form Instructions

If you have problems submitting forms or questions please direct them to the WCB Customer Support Unit.

Forms may be submitted 24 hours a day. However, there are times when the forms may not be available. Please review the Board's On-line Services Availability. Select Claims Web Forms Submissions for specific information. If you are experiencing problems you should check these web pages before contacting our WCB Customer Support Unit.