How to Bill

The appropriate bill forms for submitting charges include CMS 1500UB 04, or ADA Dental. WSI accepts the current AMA CPT® codes and modifiers, excluding consult codes. Out-of-state specific codes or guidelines are not accepted.

Billing Options

WSI requires submission of typed medical documentation to support the charges billed. Providers may submit medical bills in the following formats:


Submit bills in red and white paper format with supporting medical documentation to WSI:

  • Mail:

Workforce Safety & Insurance
PO Box 5585
Bismarck, ND 58506-5585


For EDI submission of medical bills, providers should visit Noridian or contact their EDI Support Services at 800-967-7902.