Get Wsib Form 3947a

Filling out the Wsib Form 3947a online can seem challenging, but with the right guidance, it becomes a straightforward process. This guide provides a step-by-step approach to successfully completing the form to ensure prompt payment for health services.

Follow the steps to accurately complete the Wsib Form 3947a online.

1. Click the 'Get Form' button to obtain the form and open it in an appropriate editor.
2. Begin by completing the worker information section. Enter the worker's WSIB claim number, surname, given names, and initial. Provide any available impairment or ICD 9 code, followed by the date of the incident, mailing address, date of birth, and leave the WSIB reference number blank.
3. Next, fill out the provider information section. Enter the provider or facility's full name and address, WSIB provider ID, your own invoice number for reference, and the treating provider's name. Also, include the telephone number of the person completing the form.
4. In the service/treatment information section, use a separate line for each service code. For each service, enter the description, service code, fee per service, number of services/treatments, and the total amount billed. Make sure to provide the service date by selecting the appropriate month and year.
5. Calculate the total amount billed for all services and enter this in the designated area. This will ensure accurate processing of your payment request.
6. Finally, print the form. Ensure the information is legible and complete. Sign and date the form before submission to the WSIB.
7. After completing the form, you can save changes, download it for your records, print it out for submission, or share it as needed.

Take the next step to submit your Wsib Form 3947a online and ensure you receive prompt payment for your services.