Medical Provider Resource Center
SIF provides workers’ compensation insurance to a majority of Idaho’s employers. As a medical provider, your organization may provide medical services for an injured worker covered by SIF.
We Value our Provider Partners
We work to build a partnership between you and our staff to make your experience with SIF as easy and efficient as possible. Our Medical Provider hub allows you to search for a claim number, view bill status, payments made and associated Explanation of Benefits (EOB).
Medical Provider FAQs
Medical providers may receive reimbursement for services provided by submitting your bill using one of the following document types:
- CMS 1500
- UB 04
- ADA Dental
- SIF accepts the current AMA CPT Codes and Modifiers. Out-of-state specific codes or guidelines are not accepted.
- Please always include supporting medical documentation along with the patient’s full name, social security number and/or SIF-assigned claim number, if known.
We ask other service providers, including:
- transportation services
- funeral homes
- social workers
to submit charges on the regular invoice or billing statement.
Be sure to include:
- your tax ID number
- the address where the payment is to be mailed
- the patient’s full name, social security number and/or SIF-assigned claim number, if known
Please send bills and documentation to:
P.O. Box 990004
Boise, ID 83799-0004
For any questions, please call us at (208) 332-2169. For new customers, or the first time submitting a bill to SIF, please be sure to include a W9 with the submission.
SIF pays medical bills based on the medical fee schedule approved by the Idaho Industrial Commission. View the schedules here.
Please note: Balance billing is not permitted.
Per Idaho Code Title 72-432, you cannot bill the patient for the unpaid portion of a bill paid by SIF unless it is for charges unrelated to their injury or other non-covered expenses.
For fastest processing, please log into our Medical Provider portal select Submit a Surgery/Diagnostic Testing Request Form under Communications. If you do not have a website login, download our Surgery and/or Diagnostic Testing Request form. For paper forms, return the completed copy and supporting documents by email to email@example.com, or by fax to (208) 332-2171.
Use this form to obtain prior authorization for surgical procedures, diagnostic testing, injections or other procedures or tests being recommended by the physician.
Our claims department reviews completed requests and notifies the medical provider of the results of the review.
Please do not use this form for physical medicine authorization. Contact the Claims Examiner directly for approval.
Please contact our Claims Department by phone at: (208) 332-2100.
For toll-free calls within Idaho: (800) 334-2370.
To contact a specific claims examiner about a surgery authorization or other questions, please email using the format firstname.lastname@example.org.
For provider inquiries, please contact us at email@example.com or by phone at (208) 332-2169
or (800) 334-2370 ext. 2169
Reimbursement of implants requires the submission of the official invoices with cost, along with the itemization of implants used.
We are not able to reimburse:
- Unused implants
- Equipment used to provide services, including tools and kits
The following require authorization prior to ordering or performing:
- Compound Drug Services or Physician Dispensed Drugs
- Chiropractic Services
- Durable Medical Equipment, Bracing or Prosthetics
- New Medical Technology or Therapy Services
- Nursing and Home Health Services
- Non-emergent Transportation Services
- Physical Therapy & Rehabilitation Services
- Vocational Rehabilitation Services
Upload your request via our online portal or fax your prior authorization to (208) 332-2171.
Bill corrections must be sent on a new claim form and marked "Corrected Bill" at top of the form.
Resubmit the bill in its entirety including all original lines.
*All lines of a multiple-line bill must be included in the bill resubmission
Submit a bill for reconsideration when:
- your original submission was denied for lack of documentation
- SIF has requested additional information to process your bill.
When submitting your reconsideration, be sure to include the originally requested information with your bill.
*Resubmitting a denied bill is not considered a reconsideration.
Appeal a bill when you disagree with how your bill was processed i.e., fee dispute or coding edits.
All appeals should include:
- a letter of explanation of why you disagree
- documentation to support your appeal
- SIF's EOB
Providers have 30 days from receipt of SIF's explanation of benefits to submit an appeal.
Email appeals to firstname.lastname@example.org
Physical therapy and chiropractic services must be submitted on a CMS 1500 or UB 04 form.
SIF allows up to 4 modalities/procedures to be billed per date of service, related to injury.
When billing time codes, medical documentation needs to support the time being billed for services performed. Otherwise, bills may be denied or down coded to support the documentation provided.
When treating multiple body parts for the same claim and/or injury, bill all services performed on a single day with total units per CPT code. Providers should utilize the diagnosis box 21 on CMS 1500 claim form to indicate which body part/injury is being treated.