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WorkplaceNL Form 92: Doctor's Account (Physicians)

Physicians bill WorkplaceNL for services on an injured worker's claim with this one-page Doctor's Account. Each line gives the date and time of service, the MCP fee code, the capacity, the fee claimed, time units and any surgical premium code and fee, with a check mark for the primary procedure when several are billed. A report fee claim box, with dates, covers reports.

Who completes it

The physician completes and signs the account with their WorkplaceNL physician's billing number, declaring the services were rendered by them and not already paid by WorkplaceNL. A GP billing surgical assistant services ticks standard or dedicated billing, and two surgeons working together mark operating surgeon or specialist assist.

Submitting and payment

How to submit it
Mail or fax it to WorkplaceNL; if you fax it, do not mail the original, and keep the original for your files.
Who pays
WorkplaceNL pays the total claimed on each line, made up of the fee claimed, the total unit fee for time units and any surgical premium fee, using MCP fee codes.

Good to know

  • Enter the worker's WorkplaceNL claim number, MCP number and injured part of body at the top, with their name, mailing address and telephone number.
  • When billing more than one procedure, check the primary procedure in the column next to the MCP fee code.
  • The report fee claim box sits on the same form; WorkplaceNL's companion report for physicians is the Physician's Report (Form MD).
  • The current form's header is dated August 2018, and WorkplaceNL publishes it in English as a printable PDF.

Get the official form

Download the current version from the source each time; forms change without notice.

Invoice – Physicians (Form 92)

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Can I fax and mail WorkplaceNL Form 92?

Send it one way only. The form says that if you fax it, you should not mail the original, and that you should keep the original for your files. Either way, the account needs the worker's claim number, your WorkplaceNL physician's billing number and the date of invoice.

How do surgical assistants bill WorkplaceNL on Form 92?

A GP billing surgical assistant services ticks the method of billing, standard or dedicated. When two surgeons work together on the listed procedures, each indicates whether they are the operating surgeon or the specialist assist. Surgical premium codes and fees have their own columns and are added to the line total.

What does the total claimed on WorkplaceNL Form 92 include?

Each line totals three parts: the fee claimed (a), the total unit fee for time units or intervals (b), and the surgical premium fee (c), entered where applicable. The MCP fee code identifies the service, and a check mark flags the primary procedure when you bill more than one.