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News, data, & insights about workers' comp billing

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New Patient Intake Form Available

September 7, 2017 by Catherine Montgomery

A well-crafted intake form, targeted to the California Division of Workers’ Compensation (DWC)’s billing guidelines, is the provider’s first line of defense against incorrect reimbursement. According to the DWC, a bill must be one thing above all to be considered compliant: complete. For providers, ensuring that completeness starts at intake.

Fortunately, DaisyBill has that covered.

We’re proud to announce the debut of our new intake form, strategically designed to help billing and intake staff get the information they need to generate valid, compliant Original Bills. The information providers gather using our new intake form saves time and hassle later in the billing process. With all the relevant fields for initial demographic and injury information, this intake form is tailored to save as much effort as possible down the line.

DaisyBill Intake Form

When the time comes to complete a required billing form like the CMS 1500, thorough intake pays off. To be paid quickly and correctly, a compliant Original Bill must meet the standards set out in the official DWC Billing and Payment Guide. Building a reliable framework to satisfy DWC standards comes down to gathering as much key information as possible, as soon as possible.

Our intake form provides everything providers need. The patient demographic and injury sections highlight the required information, with separate subsections for important optional information. Optional fields for contact information for adjusters, managers, and attorneys are also included.

Download the form here. Consider it our gift to you, and a sign of our commitment to making billing— and life— easier for providers in the challenging world of California workers’ comp. For further questions regarding intake, please see our FAQ page.


The new standard intake form is just one of the ways DaisyBill helps providers ensure fast, compliant billing that results in proper reimbursement. With our complete billing software, official forms like the CMS 1500 can be auto populated with information gathered during intake. That means less time, money, and resources spent on billing.

See for yourself. Schedule a free demonstration today.

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DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

Drop us a line with any news you would like us to share or any issue that concerns you.

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