Notice Of Objection To Payment Of Bill For Treatment Provided {C-8.1B}

C-8.1B - NOTICE OF OBJECTION TO A PAYMENT OF A BILL FOR TREATMENT PROVIDED. This is a required form from the New York State Workers’ Compensation Board used by insurers to dispute all or part of a medical bill submitted for treatment of an injured worker. The form lists both legal and medical treatment guideline–based objection reasons, including lack of authorization, non-established body sites, billing outside provider networks, or deviation from approved Medical Treatment Guidelines (MTGs). It must be filed within 45 days of receipt of the disputed bill and accompanied by the Explanation of Benefits (EOB) using the correct Claims Adjustment and Remittance Advice Reason Codes. Incomplete submissions may be denied. www.FormsWorkflow.com