Health Service Fee Database Certification Application

Document Number:  WKC-9351-E

Description:  To be completed by a database company to obtain certification for a health service fee database used for resolving reasonableness of fee disputes.

Comments:  This form is an electronic Microsoft Word template that can be filled out on your computer (if you have Microsoft Word).  If you do not have Microsoft Word, we are providing a PDF (WKC-9351) which you can print and complete by hand.

Content Contact:  Lynn Weinberger

Document Attachments:

WKC-9351-E (Electronic Version - Word/131 KB)

WKC-9351 (Print Version - pdf/30 KB)

*** If you need to access this form in an alternate format, please send an email to the Content Contact listed above.

*** Should you require the necessary software to view the above attachment, please go to the DWD Viewers Download Page.  Links to each specific vendor's site have been provided for you.  Thank you.

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