claims
Medical bill and claims correspondence - mailing addresses and virtual assistant
State Fund's billing page: submit medical bills, reports and claims correspondence electronically or by mail. Two P.O. boxes are published (Suisun City and Fresno); see State Fund's 'Medical Provider Billing Addresses' page for which applies. State Fund's virtual assistant answers bill status, EOR, claim number, lien settlement, address-change and UR-fax-number questions 24/7, with live chat 8 AM-5 PM. California DWC e-billing and paper billing rules apply. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
provider services
Medical provider customer service and Medical Access Assistants (MAA)
State Fund lists (888) 782-8338 for any other questions and as the Medical Access Assistants line that helps find a Medical Provider Network (MPN) doctor and schedule appointments. A second number, (800) 371-5905, appears beside it on the page but is not labeled, so it is not included. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.
Contact for applying for membership in State Fund's Medical Provider Network (MPN); for provider applications, not claim questions. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.
pharmacy help desk
Pharmacy networks (myMatrix, Express Scripts) - customer support
Menu guidance in the source recordExtension 2
Menus can change. No live call verification is claimed.
State Fund's published customer support for its pharmacy networks (myMatrix, Express Scripts Co.). A second number, (813) 247-3391, is listed on the same page. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.
provider services
Ancillary network (Healthsystems) - customer support
State Fund's ancillary network vendor Healthsystems handles physical therapy, diagnostics, durable medical equipment, home health and transportation services; this is the customer-support contact State Fund publishes. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.
fax prior auth
Utilization review - Request for Authorization fax: Bakersfield
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Bay Area Claims Services - Pleasanton
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Eureka State Contracts
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Fresno
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Inland Empire Claims Services - Riverside
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Los Angeles Claims Services - Monterey Park
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Major Case Operations
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Major Case Operations State Contracts
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Orange County Claims - Santa Ana
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Redding
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Riverside State Contracts
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Rohnert Park State Contracts
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Sacramento State Contracts
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Santa Ana State Contracts
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Stockton
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
fax prior auth
Utilization review - Request for Authorization fax: Vacaville State Contracts
State Fund requires a written DWC Request for Authorization, signed by the treating physician, faxed to the dedicated UR fax of the regional office handling the claim. Confirm the office from the claim or State Fund's virtual assistant before faxing. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.
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