Medical Provider Related MD WCC Forms

Forms cannot be filed by email attachment or FAX; only original forms with original signatures are accepted.
Forms submitted must be current and as provided by the Commission.
Altered, created/unauthorized or obsolete forms are not accepted.

The forms and informational materials below are specific to the Maryland Workers' Compensation Commission Medical Fee Guide and the providers and payers of such services provided the injured worker in Maryland. All forms/materials links utilize Adobe Reader to view, complete and/or print these materials. All questions regarding the MD WCC Medical Fee Schedule and medical claims should be sent via email: [email protected] or via telephone (410) 864-5320; outside Baltimore Metro area toll free (800) 492-0479 selecting extension 5320 when prompted, during normal business hours. COMAR 14.09.01.31 establishes our hours of business: Monday - Friday, 8:00 a.m. to 4:30 p.m., except legal holidays.
Claim for Medical Services C-51	Claim for Medical Services Info
Controversion Of Medical Claim	Guide of Medical and Surgical Fees COMAR 14.09.08

Surgeon's Report WCC Form SF-2: Complete the online form (all fields require input) and submit it to the Workers' Compensation Commission by selecting the Submit button on the electronic form. You may print/save the completed form after submission. .
Surgeon's Report WCC Form SF-2 Online Submission	Surgeon's Report WCC Form SF-2 Printable PDF - posted 7/2011

The CMS-1500 Form version 02/2012 is required A CMS 1500 02/2012 paper form provided by commercial vendors (red ink/OCR) may be used. No payer may refuse payment when a current, legible CMS 1500 form is submitted by a provider; handwritten forms may impact fulfillment by automated processes.
Sample CMS 1500 version 2/2012 (PDF) http://www.nucc.org/images/stories/PDF/1500_claim_form_2012_02.pdf