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  2. Forms Repository
  3. WKC-9351-E, Health Service Fee Database Certification Application

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/136 KB)

WKC-9351-E (Electronic  Version - pdf/160 KB)

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

Contact Information

For questions about this form, or if you need this form in an alternate format, please see the Content Contact (listed to the left)

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