How to Bill
The appropriate bill forms for submitting charges include CMS 1500, UB 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.
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:
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.