Billing

Owensboro Health will bill the employer directly for all services provided unless otherwise specified or agreed upon. To ensure you are only billed for services you authorize, please email authorization for services to occmed@owensborohealth.org.

If services are provided without an authorization form on file, payment will remain the responsibility of the employer or third‑party administrator. It is the responsibility of the employer to ensure Owensboro Health has the correct billing contact information.

Invoices are generated on the first business day of each month and are expected to be paid within 30 days of the invoice date. Accounts more than 90 days past due may be subject to collection activity, including a requirement for payment at the time of service.

Employer Services New Company Form

To initiate your account setup and receive your protocol instructions, please fill out the new company form below.

Denotes required fields

Company Name

Number of Employees

Address

City

State

ZIP Code

Phone

Fax

Billing address is same as above.

Billing Address

City

State

ZIP Code

Billing phone and fax are the same as above.

Billing Phone

Billing Fax

Designated Employer Rep: First Name

Last Name

Phone

Fax

Ok to receive results, work status, etc?

Yes

Preferred contact method for results:

Fax

Secondary Contact: First Name

Last Name

Phone

Fax

Ok to receive results, work status, etc?

Yes

Preferred contact method for results:

Fax

Work Comp Carrier

Adjuster/Contact

Phone

Fax

Address

City

State

ZIP Code

Company has:

DOT employees only

Non-DOT employees only

Both DOT and Non DOT employees

Services Needed

Pre-Employment

Physical

Drug Screen

DOT Physical

Please list what is included in your physical requirements (ex: audio, drug screen, PFT, BAT, EKG, etc.)

Please list what drug screen panel, or if it is a collect (if it is a collect please list: lab, courier and any special instructions)

Please list what is included in your physical requirements (ex: audio, drug screen, BAT, PFT, EKG, etc.)

Post-Accident

Drug Screen

Breath Alcohol Test

Post-accident drug screen preference:

All new injuries

If requested only

Please list what drug screen panel, or if it is a collect (if it is a collect please list: lab, courier and any special instructions)

Post-accident breath alcohol test preference:

All new injuries

If requested only

Only within 8 hours of injury

Special instructions/notes

Random

Drug Screen

Breath Alcohol Test

Please list what drug screen panel, or if it is a collect (if it is a collect please list: lab, courier and any special instructions)

Reasonable Suspicion

Drug Screen

Breath Alcohol Test

Please list what drug screen panel, or if it is a collect (if it is a collect please list: lab, courier and any special instructions)

Other Services

Please list any other services needed.

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Billing

Employer Services New Company Form

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