|
855-1119
|
BWC/ BWCRKAD/ BWCRKADSELF
|
SELF/SIBF
|
Self Insured (SI) Bankrupt Claims File
|
|
|
12/06/2018
|
|
|
855-1120
|
BWC/ BWCMSAD/ BWCMSAD
|
MSAD-29
|
Hospital Reimbursement Review Bill Worksheets
|
|
|
09/18/2009
|
|
|
855-1123
|
BWC/ BWCMSAD/ BWCMSAD
|
MSAD-140
|
Medical Payment Dispute Committee (MPDC) Official Files.
|
|
|
12/09/2009
|
|
|
855-1124
|
BWC/ BWCSHYG/
|
SHYG/GRSP
|
Group Rating Safety Plan Summary Form (SH2)
|
|
|
03/20/2012
|
|
|
855-1125
|
BWC/ BWCLAWS/ BWCLAWSLEGL
|
LEGL-135
|
Medical Payment Dispute Settlements Attorney Files
|
|
|
12/09/2009
|
|
|
855-1126
|
BWC/ BWCMSAD/ BWCMSAD
|
MSAD - 55
|
C 17 – Outpatient Medication Reimbursement Request Form
|
|
|
12/09/2009
|
|
|
855-1127
|
BWC/ BWCLAWS/ BWCLAWSLEGL
|
Legal-85
|
Return Gifts and Gratuities Letter
|
|
|
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
|
|
|
09/08/2023
|
|
|
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
|
|
|
02/16/2010
|
|
|
855-1132
|
BWC/ BWCRKAD/ BWCRKADRTBC
|
RTBC/RRMF
|
Retrospective Rating Master File / UB 230
|
|
|
02/16/2010
|
|
|
855-1133
|
BWC/ BWCRKAD/ BWCRKADRTBC
|
RTBC/RRPM
|
Retrospective Rating Program Material and Application Information
|
|
|
04/05/2012
|
|
|
855-1134
|
BWC/ BWCBWCA/ BWCBWCABWCA
|
BOD-1
|
BWC Board of Directors Correspondence
|
|
|
03/09/2010
|
|
|
855-1135
|
BWC/ BWCALLS/ BWCALLSALLS
|
ALLS-32
|
Employer Visits (ETA)
|
|
|
04/29/2010
|
|
|
855-1136
|
BWC/ BWCLAWS/ BWCLAWSLEGL
|
Legal-165
|
Adjudicating Committee Hearing Records
|
|
|
12/17/2015
|
|
|
855-1137
|
BWC/ BWCLAWS/ BWCLAWSLEGL
|
Legal-160
|
Adjudicating Committee and Administrator’s Designee’s Internal Correspondence
|
|
|
01/20/2011
|
|