Form DWC045M Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (Brc-Mfd) - Texas

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form DWC045M for the current year.

Form DWC045M Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (Brc-Mfd) - Texas

What Is Form DWC045M?

This is a legal form that was released by the Texas Department of Insurance - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the DWC045M form?
A: The DWC045M form is a request to schedule, reschedule, or cancel a Benefit Review Conference to appeal a medical fee dispute decision (BRC-MFD) in Texas.

Q: What is the purpose of the DWC045M form?
A: The purpose of the DWC045M form is to request a Benefit Review Conference to appeal a medical fee dispute decision in Texas.

Q: When should I use the DWC045M form?
A: You should use the DWC045M form when you want to schedule, reschedule, or cancel a Benefit Review Conference to appeal a medical fee dispute decision in Texas.

Q: Do I need to fill out the DWC045M form?
A: Yes, you need to fill out the DWC045M form if you want to schedule, reschedule, or cancel a Benefit Review Conference to appeal a medical fee dispute decision in Texas.

Q: Are there any fees associated with submitting the DWC045M form?
A: No, there are no fees associated with submitting the DWC045M form.

Q: Is the DWC045M form specific to Texas?
A: Yes, the DWC045M form is specific to Texas and is used to appeal medical fee dispute decisions in the state.

ADVERTISEMENT

Form Details:

  • Released on January 1, 2019;
  • The latest edition provided by the Texas Department of Insurance;
  • 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 Form DWC045M by clicking the link below or browse more documents and templates provided by the Texas Department of Insurance.

Download Form DWC045M Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (Brc-Mfd) - Texas

4.5 of 5 (56 votes)
  • Form DWC045M Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (Brc-Mfd) - Texas

    1

  • Form DWC045M Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (Brc-Mfd) - Texas, Page 2

    2

  • Form DWC045M Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (Brc-Mfd) - Texas, Page 3

    3

  • Form DWC045M Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (Brc-Mfd) - Texas, Page 4

    4

  • Form DWC045M Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (Brc-Mfd) - Texas, Page 1
  • Form DWC045M Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (Brc-Mfd) - Texas, Page 2
  • Form DWC045M Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (Brc-Mfd) - Texas, Page 3
  • Form DWC045M Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (Brc-Mfd) - Texas, Page 4
Prev 1 2 3 4 Next
ADVERTISEMENT