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855-1109
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BWC/ BWCSHYG/
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S&H/SC-1
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Safety Council New Enrollments, Deletions and Policy Number Updates
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09/09/2020
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855-1110
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BWC/ BWCSHYG/
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S&H/SC-2
|
Safety Council Evaluations and Sign-in Sheets
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07/16/2009
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855-1111
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BWC/ BWCLAWS/ BWCLAWSLEGL
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LEGL-70
|
Santos Reimbursement Information
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10/11/2023
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855-1112
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BWC/ BWCLAWS/ BWCLAWSLEGL
|
LEGL-110
|
Mock File Inventory
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08/20/2009
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855-1113
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BWC/ BWCMSAD/ BWCMSAD
|
MSAD-30
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Hospital Reimbursement Appeals
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|
09/09/2009
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855-1114
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BWC/ BWCRKAD/ BWCRKADRTBC
|
RTBC/RAR
|
Retrospective Rating Plan Annual Loss Statement (Retro Annual Report)
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|
|
09/11/2009
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855-1116
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BWC/ BWCLAWS/ BWCLAWSLEGL
|
LEGL-120
|
Court Docket Worksheet
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|
|
09/18/2009
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855-1117
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BWC/ BWCLAWS/ BWCLAWSLEGL
|
LEGL-100
|
Appeals and Continuances Spreadsheet
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|
|
09/18/2009
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855-1118
|
BWC/ BWCLAWS/ BWCLAWSLEGL
|
LEGL-111
|
Attorney General’s Office Litigation Summary Worksheet
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|
|
09/13/2023
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|
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855-1119
|
BWC/ BWCRKAD/ BWCRKADSELF
|
SELF/SIBF
|
Self Insured (SI) Bankrupt Claims File
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|
|
12/06/2018
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|
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855-1120
|
BWC/ BWCMSAD/ BWCMSAD
|
MSAD-29
|
Hospital Reimbursement Review Bill Worksheets
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|
|
09/18/2009
|
|
|
855-1123
|
BWC/ BWCMSAD/ BWCMSAD
|
MSAD-140
|
Medical Payment Dispute Committee (MPDC) Official Files.
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|
|
12/09/2009
|
|
|
855-1124
|
BWC/ BWCSHYG/
|
SHYG/GRSP
|
Group Rating Safety Plan Summary Form (SH2)
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|
|
03/20/2012
|
|
|
855-1125
|
BWC/ BWCLAWS/ BWCLAWSLEGL
|
LEGL-135
|
Medical Payment Dispute Settlements Attorney Files
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|
|
12/09/2009
|
|
|
855-1126
|
BWC/ BWCMSAD/ BWCMSAD
|
MSAD - 55
|
C 17 – Outpatient Medication Reimbursement Request Form
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|
|
12/09/2009
|
|
|
855-1127
|
BWC/ BWCLAWS/ BWCLAWSLEGL
|
Legal-85
|
Return Gifts and Gratuities Letter
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|
|
09/08/2023
|
|
|
855-1128
|
BWC/ BWCLAWS/ BWCLAWSLEGL
|
Subro/Fra2
|
Subrogation Access Database
|
|
|
12/23/2009
|
|
|
855-1129
|
BWC/ BWCLAWS/ BWCLAWSLEGL
|
Legal-90
|
Dual Public Employment Form for R.C. 102.04(D) Statement
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|
|
09/08/2023
|
|
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855-1130
|
BWC/ BWCMSAD/ BWCMSAD
|
MSAD-110
|
Rehabilitation Services Commission (RSC) Weekly Eligibility File Transfer
|
|
|
02/16/2010
|
|
|
855-1131
|
BWC/ BWCMSAD/ BWCMSAD
|
MSAD-105
|
Rehabilitation Services Commission (RSC) Monthly Management File Transfer
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|
|
02/16/2010
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