Request an Appeal

A provider should review the reason code to determine if the denied or reduced charge is eligible for an appeal. The Medical Bill Appeal (M6) form initiates a second bill review process for medical treatment or goods to dispute the amount of payment

Complete M6  form and return with supporting documentation to WSI:

  • Mail:

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

  • Fax: 701-328-3765 or 888-786-8695

When to Rebill

A provider should submit a corrected bill if they billed the wrong CPT code, incorrect units or have delayed charges.