Form WC-381 Medical Provider Application for Payment or Reimbursement of Medical Payment - New Jersey

Form WC-381 Medical Provider Application for Payment or Reimbursement of Medical Payment - New Jersey

What Is Form WC-381?

This is a legal form that was released by the New Jersey Department of Labor & Workforce Development - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form WC-381?
A: Form WC-381 is a Medical Provider Application for Payment or Reimbursement of Medical Payment in New Jersey.

Q: Who can use Form WC-381?
A: Medical providers can use Form WC-381 to request payment or reimbursement for medical services provided in New Jersey.

Q: What is the purpose of Form WC-381?
A: The purpose of Form WC-381 is to request payment or reimbursement for medical services related to a workers' compensation claim in New Jersey.

Q: What information is required on Form WC-381?
A: Form WC-381 requires information such as the injured worker's name, date of injury, diagnosis, treatments provided, and the amount requested for payment or reimbursement.

Q: How do I submit Form WC-381?
A: Form WC-381 should be submitted to the workers' compensation insurance carrier or third-party administrator handling the claim.

Q: Is there a deadline for submitting Form WC-381?
A: Yes, Form WC-381 should be submitted within one year from the date of service or within one year from the date the medical provider becomes aware of the need for treatment.

Q: Can I submit multiple Form WC-381 for the same claim?
A: Yes, you can submit multiple Form WC-381 for different dates of service or multiple medical providers involved in the same claim.

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Form Details:

  • Released on August 26, 2015;
  • The latest edition provided by the New Jersey Department of Labor & Workforce Development;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form WC-381 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Labor & Workforce Development.

Download Form WC-381 Medical Provider Application for Payment or Reimbursement of Medical Payment - New Jersey

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