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Get TX DWC060 2012-2024

Provide the requested information in the table below. Dates of Service Treatment or Service Amount in Dispute Codes in Dispute Billed Paid Place of Service Code or Description TOTAL For TDI-DWC Use Only DWC060 Rev. 06/12 Page 1 of 4 Treatment or Service TOTAL from Page 1 GRAND TOTAL DWC Claim Number Frequently Asked Questions What documentation is required when filing the DWC Form-060 The required documentation of disputed services that must acco.

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