Kentucky Workers' Compensation Medical Disputes: Form 112 Guide

Kentucky recodified many Department of Workers' Claims regulations from 803 KAR Chapter 25 to 120 KAR Chapter 1 effective in 2026. Older forms and guidance may still display the former citation. This guide uses the current 120 KAR citations where available and notes the operational continuity. It is a provider workflow overview as of October 7, 2026, not a filing instruction or legal opinion for a particular claim.

Kentucky medical-dispute workflow at a glance

1. Classify the dispute before selecting the remedy

Current 120 KAR 1:012 covers disputes about payment, nonpayment, reasonableness, necessity, work-relatedness, and rendered or proposed medical treatment or services under KRS Chapter 342. Those categories are related but not interchangeable. A coding reduction or fee-schedule calculation may begin with medical bill audit. A treatment-necessity dispute may require utilization review. A carrier's position that the condition is not work-related or that the claim is not compensable may require broader proof.

2. Complete utilization review or bill-audit steps when required

Kentucky's Department of Workers' Claims states that when utilization review applies and has not been completed, the medical dispute will not be ready for adjudication by an administrative law judge. Medical bill-audit rules likewise create a reconsideration path for payment calculations. The provider should identify the review vendor, initial decision date, reconsideration deadline, required request method, supporting material, final decision, and physician or audit rationale.

Current 120 KAR 1:096 states that, following a final medical bill-audit reconsideration decision, a provider disputing the payment amount must file a medical fee dispute within thirty days. That is a rule-specific trigger, not a universal deadline for every medical issue. Calendar it from the actual final reconsideration decision, preserve receipt evidence, and obtain Kentucky-specific advice when the trigger, service, or party status is uncertain.

3. Build the Form 112 evidence packet

Under 120 KAR 1:012, a Form 112 packet includes copies of the disputed bills, a supporting affidavit with facts showing entitlement to the requested relief, necessary expert testimony, and the final utilization-review or medical-bill-audit decision with supporting physician opinion. The exact attachments depend on the issue. A provider's affidavit should be factual, identify the records and amounts, and avoid legal conclusions beyond the affiant's knowledge.

• Form 112 identifies every disputed bill, service, treatment, and requested result consistently.
• The employee, employer, carrier, claims administrator, provider, and existing claim number are verified.
• Itemized bills and statements match the amount in the form and ledger.
• Delivery evidence shows when complete billing material was submitted.
• EOBs, denials, audit explanations, and all reconsideration decisions are included.
• Clinical records and expert support address the actual issue.
• The affidavit authenticates facts within the affiant's knowledge.
• The final UR or bill-audit decision and supporting opinion are complete.
• Prior orders, awards, settlements, and pending pleadings are reviewed for case posture.
• Copies and service materials are prepared for every required party.

4. Match the procedure to the claim's posture

The regulation changes the filing mechanics depending on whether an application for adjustment of claim exists, is pending, or has already ended in a final order or award. When no application has been filed, 120 KAR 1:012 requires sufficient copies for service on the employee, employer, medical provider, and other named parties. When a claim is pending, the movant must address joinder and service in that action. After final resolution, a motion to reopen may be required with the Form 112.

5. Separate provider rights from the worker's broader claim

A provider may file Form 112, but provider participation does not automatically make every underlying compensability or causation issue simple. The worker, employer, carrier, and provider can have different interests and evidence. Confirm who seeks relief, who bears the burden on each issue, whether the provider has been joined, and whether the requested order would affect treatment, payment, or both.

Do not balance bill the patient merely because payment is delayed or reduced. Kentucky rules restrict patient billing in specified circumstances, including after services have been found unreasonable or unnecessary where the provider was joined and had an opportunity to present contrary evidence. Review the order, compensability, provider-party status, and current rule before directing any patient statement or collection activity.

6. Reconcile the decision and payment

1. Read the final order for the exact bills, treatment, parties, and relief decided.
2. Separate uncontested amounts from the portion adjudicated or reserved.
3. Apply the correct fee schedule, contract, audit result, credits, and prior payments.
4. Send the order and calculation through the payer's designated channel with delivery proof.
5. Track payment, remittance, interest or other relief only as actually ordered or legally supported.
6. Update the patient account so prohibited or unresolved balances are not transferred to collections.
7. Preserve the complete administrative record and any appeal or reopening deadlines for counsel review.

Provider quality-control checklist

• Dispute type and exact amount or treatment are defined.
• Current 120 KAR citation is used, with former 803 KAR citation noted only when helpful.
• Required UR or medical bill-audit reconsideration is complete.
• Thirty-day post-reconsideration trigger is calendared when 120 KAR 1:096 applies.
• All disputed bills, decisions, opinions, and factual affidavit are assembled.
• Case posture, joinder, service, and reopening requirements are confirmed.
• Uncontested charges are tracked separately.
• Patient billing is held for rule- and order-specific review.
• Requested relief matches the evidence and party authority.
• Claim-specific filing and appeal decisions are reviewed by qualified Kentucky counsel.

Related Millennova Legal resources

See Millennova Legal's workers' compensation reimbursement services, Kentucky auto-accident guide, Kentucky PIP 2026 changes guide, and Virginia medical fee-dispute guide.

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