Help for Injured Workers

Medical bills must be submitted CMS 1500 or UB04 forms and include claimant name, complete claim number, provider name, provider billing address, provider tax ID, and supporting medical records. They can be submitted two ways:

1. Electronic billing via Jopari, payer ID is J1496 or

2. Mail to Preferred Employers Insurance, PO Box 14817, Lexington, KY 40512

Bills are not accepted via fax or email

All medical bill payments are issued via Jopari. Each provider elects to receive payments either via; virtual card, EFT/ACH or Paper Check. Payments will be sent via virtual card if another option has not been selected. Please contact Jopari at 1-800-630-3060 for further assistance in setting up your desired payment option.

Medical providers can check bill status using our easy MedBill Lookup Tool. There is no login required and you can obtain date of receipt, paid amounts, check numbers and request an EOB: https://peiportal.peiwc.com/wps/portal/MBRBillLookup/peiwc

Second Bill Review

A request for Second Bill Review must be made within 90 days of service of the explanation of review that explained why the payment you sought in the initial bill was reduced or denied. To initiate the process please submit the following:

• A completed Provider’s Request for Second Bill Review (DWC Form SBR-1) 
• The original bill and supporting documentation

Mail to:

Preferred Employers Insurance 
P.O. Box 14817 
Lexington, KY 40512 
 

The Request for Second Bill Review must conform to the requirements of the Division of Workers’ Compensation Medical Billing and Payment Guide, and regulations at CA Code of Regulations, Title 8 sections 9792.5.4 and 9792.5. For more information please click here.

If the only dispute is the amount of payment and the health care provider, health care facility, or billing agent/assignee does not request a SBR within 90 days of the service of the explanation of review, the bill shall be deemed satisfied and neither the employer nor the employee shall be liable for any further payment. 
  
Independent Bill Review

If the only dispute between a medical provider and a claims administrator regarding a bill for medical treatment services or a bill for medical-legal expenses is the amount of payment and the second bill review did not resolve the dispute, the provider may request independent bill review (IBR) from a conflict-free payment and billing expert. The Division of Workers’ Compensation (DWC) has contracted with an independent bill review organization (IBRO) to provide an efficient means of resolving workers’ compensation billing disputes. 
IBR can be requested electronically or by submitting this form.

The electronic form can be accessed at DWC’s website at DWC Independent Bill Review (IBR) (ca.gov)

If you have a question about how a medical bill was processed, please contact the Medical Bill Review team at 800-732-0153.