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Indiana Application for Adjustment of Claim for Provider Fee - SF 18487

State:
Indiana
Control #:
IN-18487-WC
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PDF
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Description

Application for Adjustment of Claim for Provider Fee - SF 18487

Indiana Application for Adjustment of Claim for Provider Fee — SF 18487 is a form completed by a healthcare provider in Indiana to request an adjustment of a provider fee. The form is used to request adjustments to the fee schedule on the basis of a change in circumstances, such as a change in the medical record or the receipt of additional information. The form includes sections for the provider to provide information about the patient and the services provided, as well as a section for the provider to explain the circumstances that necessitate the adjustment of the fee. The provider must also attach any supporting documentation to the form to assist with the adjustment request. There are two types of Indiana Application for Adjustment of Claim for Provider Fee — SF 18487 forms: one for inpatient services and one for outpatient services.

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FAQ

Indiana Workers' Compensation Act The Indiana General Assembly passed the Workers' Compensation Act of Indiana in 1915. The Act created a workers' compensation system that provides benefits to sick or injured workers hurt by their job to help them recover and return to work.

The Indiana Workers Compensation Act does not provide compensation for pain and suffering related to workplace injuries or occupational diseases. Non-economic damages for pain and suffering are not part of workers compensation benefits.

In Indiana employers are required to purchase workers' compensation coverage if they employ one or more workers. Sole Proprietors, Partners and LLC Members are all excluded from coverage, but have the option to be included. Corporate Officers are included in coverage, but may elect to included.

Indiana Workers' Compensation Coverage. Workers are not required to prove that their employer was at fault for their job-related injury to receive workers' comp benefits. Indiana workers' compensation benefits can help cover an employee's medical treatment if they're sick or hurt from a work-related cause.

Form 29109: Application for Adjustment of Claim The form may be filed by an injured worker who believes that he is entitled to compensation or medical benefits. An employer who believes that compensation should be terminated may also file the form. This form is also used to attempt to re-open a settled claim.

A: The law requires most businesses to have worker's compensation insurance. If you are injured while working at your job, you may be entitled to workers' compensation benefits. Q: When should I report an accident that happened on the job?

In Indiana, these benefits are calculated as two-thirds of your average weekly wage during the year before your injury, up to a legal maximum.

How to File a Workers' Compensation Claim in Indiana Step-by-step process for filing a workers' comp claim. Step #1: Seek medical attention. Step #2: Notify your employer. Step #3: Make certain your employer files the necessary form. Step #4: Wait to receive a decision from the insurance company.

More info

Claim For Medical Reimbursement. Application for Adjustment of Claim for Provider Fee (Form 18487).A "Provider's Request for Adjustment" form and reference the original ICN and rendering provider number. Remittance Advice Detail.

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Indiana Application for Adjustment of Claim for Provider Fee - SF 18487