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This version of the form is not currently in use and is provided for reference only. Download this version of
Form F207-207-000
for the current year.
Form F207-207-000 Self-insurance Medical Provider Billing Dispute Form - Washington
What Is Form F207-207-000?
This is a legal form that was released by the Washington State Department of Labor and Industries - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form F207-207-000?A: Form F207-207-000 is the Self-insurance Medical Provider Billing Dispute Form used in Washington.
Q: Who can use Form F207-207-000?A: Medical providers who have a dispute with a self-insured employer or their third-party administrator in Washington can use Form F207-207-000.
Q: What is the purpose of Form F207-207-000?A: The purpose of Form F207-207-000 is to provide a means for medical providers to dispute billing issues with self-insured employers or their third-party administrators.
Q: What information is required on Form F207-207-000?A: Form F207-207-000 requires the medical provider's contact information, details of the disputed billing, and any supporting documentation.
Form Details:
- Released on December 1, 2019;
- The latest edition provided by the Washington State Department of Labor and Industries;
- 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 F207-207-000 by clicking the link below or browse more documents and templates provided by the Washington State Department of Labor and Industries.
