CLAIM LOCATION - ASSIGNMENT SCREEN

This screen provides information associated with claim numbers entered by you. The information includes the claim location (both the current and previous locations), claim status, claim type, injured worker name, date of injury, and the name and phone number of the BWC representative assigned to the claim.


INJURY STATUS SCREEN

This screen provides information regarding an injured worker's injury status. Information includes an ICD number and description of the injury, a location, site, application, status, and status date. The field titled "Primary" is not currently used. It will be used at a later date.

This screen can accommodate up to 12 rows of information at one time. You can view additional rows of data by scrolling. Function keys F7 and F8 are provided for scrolling backward and forward.


CLAIM PROVIDERS SCREEN

This screen provides information regarding health care providers associated with a claim. Information includes provider identification numbers, provider names, and phone numbers. Status, begin dates, end dates and the name of the physician of record (POR) are also included.

This screen can accommodate up to 13 rows of information at one time. You can view additional rows of data by scrolling. Function keys F7 and F8 are provided for scrolling backward and forward.


CLAIM EMPLOYERS SCREEN

This screen provides information regarding employers associated with a claim. Information includes the employer's policy number, the employer manual code and sub code, and coverage at the date of injury. It also includes the employer's legal entity name, the doing business as name, phone number , and it identifies whether the employer is self-ensured. The screen also shows whether the employer is enrolled in the $1,000.00 program. The MCO ID and name are provided along with the MCO effective date. The employer representative's name and ID are shown as well as the representative's status and the status date.

This screen can accommodate up to 6 rows of information at one time. You can view additional rows of data by scrolling. Function keys F7 and F8 are provided for scrolling backward and forward.


LOOK-UP EMPLOYER SCREEN

This screen provides you with a method for looking up employer information. By entering one of the following pieces of information about the employer, you can find the policy number for that employer, the employer's legal entity name, and the city where the employer is located. You can enter a Policy Number, a Federal Tax ID or SSN, the Legal Entity Name, or the Doing Business As name to find the information needed. When Legal Entity Name or a Doing Business as name is entered, the city must also be entered.

This screen can accommodate up to 10 rows of information at one time. You can view additional rows of data by scrolling. Function keys F7 and F8 are provided for scrolling backward and forward.


LOOK-UP AUTHORIZED REPRESENTATIVE SCREEN

This screen will provide information regarding employer's authorized representatives. Based on input of a policy number which may be passed from a previous screen or input by you, the screen will show the employer representative's name, firm, phone number, address, status, and status date.

This screen can accommodate up to 10 rows of information at one time. You can view additional rows of data by scrolling. Function keys F7 and F8 are provided for scrolling backward and forward.


LOOK-UP EMPLOYER INFORMATION SCREEN

This screen will provide information about an employer including Federal Tax ID, Legal Entity Name, Doing Business As name, address, business phone number, fax number, Managed Care Organization (MCO) Identification, MCO name, MCO effective date, and MCO phone number. It will also show the policy status and the C116 (sole proprietor or partnership) status.


LOOK-UP EMPLOYER MANUAL SCREEN

After entry of a valid policy number, this screen will show a list of employer manual numbers, sub-numbers, a description, status, and status date.

This screen can accommodate up to 10 rows of information at one time. You can view additional rows of data by scrolling. Function keys F7 and F8 are provided for scrolling backward and forward.


LOOK-UP PROVIDER SCREEN

This screen allows you to look up a provider name or a provider number. You can enter information in either the Provider Number field or the Provider Name field. The BWC's software will search the file and show both the Provider Name and Provider Number on the screen. If there is no exact match the software will fill the screen with the closest match in the file.

This screen can accommodate up to 13 rows of information at one time. You can view additional rows of data by scrolling. Function keys F7 and F8 are provided for scrolling backward and forward.


PROVIDER INFORMATION SCREEN

This screen will show information about the Provider whose identification number appears on the screen. The information includes Provider Name, Address 1, Address 2, Business Phone and extension, Provider Status and status date, Provider Type, Payment Media, and Tax ID Type. The screen will also indicate two of the Provider's specialties and the associated dates of certification.