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Form DFS-F5-DWC-10 Statement of Charges for Drugs and Medical Equipment & Supplies - Florida
What Is Form DFS-F5-DWC-10?
This is a legal form that was released by the Florida Department of Financial Services - a government authority operating within Florida. Check the official instructions before completing and submitting the form.
FAQ
Q: What is DFS-F5-DWC-10?A: DFS-F5-DWC-10 is the form used in Florida to file a Statement of Charges for Drugs and Medical Equipment & Supplies.
Q: What is the purpose of DFS-F5-DWC-10?A: The purpose of DFS-F5-DWC-10 is to request reimbursement for drugs and medical equipment & supplies provided to injured workers in Florida.
Q: Who uses DFS-F5-DWC-10?A: DFS-F5-DWC-10 is used by healthcare providers and suppliers who have provided drugs and medical equipment & supplies to injured workers in Florida.
Q: What information is required on DFS-F5-DWC-10?A: DFS-F5-DWC-10 requires information such as the injured worker's name, date of birth, claim number, and details of the drugs or medical equipment & supplies provided.
Q: What supporting documentation should be included with DFS-F5-DWC-10?A: Supporting documentation such as invoices, receipts, and medical records should be included with DFS-F5-DWC-10 to substantiate the charges.
Q: Are there any fees associated with filing DFS-F5-DWC-10?A: There are no fees associated with filing DFS-F5-DWC-10.
Q: What is the deadline for filing DFS-F5-DWC-10?A: DFS-F5-DWC-10 should be filed within one year from the date the drugs or medical equipment & supplies were provided.
Q: What happens after DFS-F5-DWC-10 is filed?A: After DFS-F5-DWC-10 is filed, the insurance carrier or self-insured employer will review the charges and determine whether reimbursement will be provided.
Q: Is there an appeals process if reimbursement is denied?A: Yes, if reimbursement is denied, the healthcare provider or supplier can request a hearing before a Judge of Compensation Claims.
Q: Are there any penalties for fraudulent or false claims filed using DFS-F5-DWC-10?A: Yes, there are penalties for fraudulent or false claims, including fines and potential criminal charges.
Form Details:
- Released on January 1, 2015;
- The latest edition provided by the Florida Department of Financial Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form DFS-F5-DWC-10 by clicking the link below or browse more documents and templates provided by the Florida Department of Financial Services.
