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This version of the form is not currently in use and is provided for reference only. Download this version of
MFDR Form 19
for the current year.
MFDR Form 19 Provider Request for Medical Fee Dispute Resolution - Oklahoma
What Is MFDR Form 19?
This is a legal form that was released by the Oklahoma Workers Compensation Commission - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is MFDR Form 19?
A: MFDR Form 19 is the Provider Request for Medical Fee Dispute Resolution.
Q: What is the purpose of MFDR Form 19?
A: The purpose of MFDR Form 19 is to request the resolution of a medical fee dispute in Oklahoma.
Q: Who can use MFDR Form 19?
A: MFDR Form 19 can be used by medical providers in Oklahoma who have a dispute over medical fees.
Q: How can MFDR Form 19 be submitted?
A: MFDR Form 19 can be submitted electronically or by mail to the Oklahoma Workers' Compensation Commission.
Q: Are there any fees for submitting MFDR Form 19?
A: No, there are no fees for submitting MFDR Form 19.
Q: What happens after submitting MFDR Form 19?
A: After submitting MFDR Form 19, the dispute will be reviewed by the Medical Fee Dispute Resolution Unit of the Oklahoma Workers' Compensation Commission.
Form Details:
- Released on April 18, 2018;
- The latest edition provided by the Oklahoma Workers Compensation Commission;
- 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 fillable version of MFDR Form 19 by clicking the link below or browse more documents and templates provided by the Oklahoma Workers Compensation Commission.
