Filing a DWC Audit Complaint
Step 1 — Open the complaint from a worked bill
On a bill that's been processed, denied, rejected, accepted-with-no-response, or is appealing, click Audit Complaint (an alert-octagon icon). The dialog explains it's alerting the Division of Workers' Compensation that this claims administrator failed to process the bill compliantly. It's free to file, and Mindbill tracks and aggregates every complaint across your providers.
Step 2 — Pick a contextual reason
The Reason dropdown isn't a flat list — Mindbill filters it to the reasons that actually fit this bill's submission type, delivery method, and status, in priority order. A denied bill surfaces 'Improper denial' and 'Underpayment'; an accepted bill with no EOR surfaces the missing/late-EOR reasons; a Second Review bill surfaces the SBR-specific reasons first. Each reason shows a plain-English description and carries its CCR/LC citation onto the complaint. ('Other' is always available as the catch-all.)
Step 3 — Enter the physical address (no P.O. Box)
Fill in the Claims Administrator physical address — line 1, city, state, and ZIP are all required. This is the single most important field: the DWC Audit Unit serves the complaint to the adjuster's physical office, so a P.O. Box will be rejected. Mindbill detects a P.O. Box-looking address and shows a warning to call the adjuster for the street address. You cannot submit until the address is complete.
Step 4 — Set the confidential flag and CC email
Flip on Confidential complaint to suppress your organization's identity in the copy served to the claims administrator — the DWC still receives your full filer info, but the payer doesn't see who reported them. Optionally add a CC email (validated as a single address) to copy someone — the adjuster, your own records — on the filing.
Step 5 — Attach the non-compliant correspondence
Under Supporting document, attach the offending EOR or denial letter from the bill's documents — the proof of what went wrong. Don't attach the medical report or the bill copy: Mindbill appends the full bill packet automatically on dispatch. Add an optional narrative describing what happened in detail — it improves the audit weight of the complaint.
Step 6 — Preview and file
Click Preview form to open the served document in a new tab and review it, then File Audit Complaint. The complaint is saved to the bill, and Mindbill batches submissions and emails the DWC audit unit. What gets sent: bill metadata, the claim number, claims-admin contact info, the EOR text, 277 acknowledgment timestamps, and your structured reason. You can re-open the dialog later to edit or clear the complaint.
When a claims administrator mishandles a bill — no EOR within the statutory window, an improper denial, an underpayment below the Medical-Legal Fee Schedule — you can alert the DWC's Audit & Enforcement Unit with an Audit Complaint. It's free to file, and Mindbill builds the structured complaint from the bill, picking the relevant reason types for that bill's situation. The catch the DWC enforces is the served address: it must be the claims administrator's physical location, never a P.O. Box — so Mindbill flags one before you can submit.