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Form WC-117H Provider's Report of Claim & Request for Medical Payment - Michigan
What Is Form WC-117H?
This is a legal form that was released by the Michigan Department of Labor and Economic Opportunity - a government authority operating within Michigan. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form WC-117H?
A: Form WC-117H is the Provider's Report of Claim & Request for Medical Payment.
Q: What is the purpose of Form WC-117H?
A: The purpose of Form WC-117H is for healthcare providers to report and request payment for medical services related to a workers' compensation claim in Michigan.
Q: Who needs to fill out Form WC-117H?
A: Healthcare providers who have treated a patient with a work-related injury in Michigan need to fill out Form WC-117H.
Q: What information is required on Form WC-117H?
A: Form WC-117H requires information about the patient, the healthcare provider, the injury or illness, and the medical services provided.
Q: Is Form WC-117H mandatory to submit a claim for medical payment?
A: Yes, submitting Form WC-117H is mandatory to request payment for medical services related to a workers' compensation claim in Michigan.
Form Details:
- Released on August 1, 2019;
- The latest edition provided by the Michigan Department of Labor and Economic Opportunity;
- 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 WC-117H by clicking the link below or browse more documents and templates provided by the Michigan Department of Labor and Economic Opportunity.
