North Dakota
Workers Comp
Last updated: 10/3/2023
Medical Bill Appeal- Retrospective Review Request {SFN 58310}
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Description
SFN 58310, MEDICAL BILL APPEAL-RETROSPECTIVE REVIEW REQUEST MEDICAL SERVICES DIVISION SFN 58310 (07/01/23) 1600 E Century Ave, Ste 1 PO Box 5585 Bismarck ND 58506-5585 Telephone 800-777- 5033 Toll Free Fax 888-786-8695 TTY (hearing impaired) 800-366 - 6888 Fraud and Safety Hotline 800- 243 -3331 www.workforcesafety.com www.FormsWorkFlow.com
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