Official Forms, Fee Schedules & Dispute Resources
Automated repository of primary regulatory documents, official arbitration petition forms, medical fee schedules, and statutory disclosure templates.
Directly Sourced Primary Documents
Every form and regulatory schedule in this library is sourced directly from authoritative agency repositories (CMS, State Departments of Insurance, Workers' Compensation Boards) to ensure direct compliance with current statutory standards.
CMS Federal Independent Dispute Resolution (IDR) Portal & Initiation Guidance
Official Centers for Medicare & Medicaid Services portal instructions and statutory initiation requirements for healthcare providers and certified IDR entities under 45 CFR § 149.510.
Standard Open Negotiation Notice & Instructions (CMS-10779)
Standardized federal notice form issued by CMS, DOL, and the Department of the Treasury required to initiate the mandatory 30-business-day open negotiation period prior to federal IDR filing.
New Jersey DOBI Standardized PIP Post-Service Appeal Administrative Form
Official New Jersey Department of Banking and Insurance (DOBI) mandatory post-service appeal form pursuant to N.J.A.C. 11:3-4.7B required before demanding arbitration before Forthright Solutions.
New York Regulation 68 AAA No-Fault Arbitration Rules & Tribunal Portal
Comprehensive administrative procedural regulations governing New York State No-Fault dispute resolution before the American Arbitration Association pursuant to 11 NYCRR 65-4.
California DWC Form SBR-1: Request for Second Bill Review
Official State of California Division of Workers' Compensation statutory form SBR-1 for medical bill disputes required under California Labor Code Section 4603.2 and 8 CCR § 9792.5.5.
Texas TDI Senate Bill 1264 Out-of-Network Claim Dispute Portal
Official Texas Department of Insurance portal for mandatory state arbitration and mediation of surprise medical bills from fully insured state-regulated health plans under Texas Insurance Code Chapter 1467.
Texas DWC Medical Fee Dispute Resolution (MFDR) Form DWC-060 Portal
Official regulatory portal and filing instructions for medical fee disputes between healthcare providers and workers' compensation insurance carriers administered by the Texas Department of Insurance Division of Workers' Compensation under 28 TAC § 133.307.
Florida DFS Division of Workers' Compensation Rule 69L-7 Reimbursement Manual
Official State of Florida health care provider reimbursement guidelines and statutory petition process for medical billing disputes under Florida Statutes § 440.13.
CMS Model Good Faith Estimate (GFE) Template Form (CMS-10791)
Standardized federal template issued by CMS for healthcare providers and facilities to issue statutory Good Faith Estimates to uninsured and self-pay patients under 45 CFR § 149.610.
CMS Model Notice: Right to Receive a Good Faith Estimate of Expected Charges
Mandatory written disclosure notice template required by federal regulations to be posted on provider websites and provided at point of intake to uninsured individuals.
Standard Irrevocable Assignment of Benefits (AOB) & Direct Standing Agreement
Healthcare provider intake template containing irrevocable assignment of insurance benefits, power of attorney for billing appeals, direct right of action, and arbitration standing provisions.