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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). An electronic PDF (WKC-9351-E) is also provided for your convenience.

Content Contact: Lynn Weinberger

Document Attachments:

WKC-9351-E (Electronic Version - Word/132 KB)

WKC-9351-E (Electronic  Version - pdf/31 KB)

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.