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WWW.PRIMECLINICAL.COM

 

Intellect™

 

 

SAMPLE - BILLING WORKER STATEMENTS

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Batch and Group of Patients

 

Scroll through the samples, OR click on a specific option to go directly to its' sample:

 

1 (Standard Workers Comp Statement)

2

3

WC Form 1

WC Form 2

PI Form 1

PI Form 2

 

 

In keeping with the 2010 change from WCAB case numbers to ADJ case numbers, effective version 15.01.09, the labels on options 1, 2, and 3 of the Worker’s Comp statements have been changed to ADJ #1, ADJ #2, and ADJ #3, as indicated on Option 1 below.

 

 

Option 1 - Standard Worker's Comp Statement

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2

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3

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WC FORM1 – Effective version 13.08.20

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WC FORM2 – Effective version 13.08.20

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PI FORM1 Effective version 13.08.20

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PI FORM2 Effective version 13.08.20

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