Section 20-2-II - FORMS AND DOCUMENTATIONA. Valid requests for resolution of a dispute must be submitted on the "Request for Resolution of Dispute" form (see the Forms section or http://www.mwcc.ms.gov/#/medicalFeeSchedule [File Link Not Available]) along with the following: 1. Copies of the original and resubmitted bills in dispute that include dates of service, procedure codes, charges for services rendered and any payment received, and an explanation of any unusual services or circumstances; 2. EOR including the specific reimbursement; 3. Supporting documentation and correspondence; 4. Specific information regarding contact with the payer; and5. Any other information deemed relevant by the applicant for dispute resolution.B. A Request for Resolution of Dispute must be submitted to: Mississippi Workers' Compensation Commission Cost Containment Division 1428 Lakeland Drive P.O. Box 5300 Jackson, MS 39296-5300 C. A party, whether payer, provider, or patient, shall certify that a copy of the Request for Resolution of Dispute and/or the Response to such Request, and any supporting documentation, being filed with the MWCC has been provided to the other interested parties or their representatives by certified mail simultaneously with the filing to the MWCC. This requirement shall also apply when a party files a request seeking review of a dispute by the MWCC.