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If yes please check all that apply AABB AOA ASHI CAP Date of Most Recent CLIA Accreditation CLIA Certification COLA JCAHO Please attach a copy of your certification s. You will continue to receive checks during this period. Please return this form to ACT-19 Rev. 12-2013 F a x Blue Cross and Blue Shield of Alabama. Signature Required Title Required Submission Instructions Fax Fax the signed and completed form to Attn Credentialing 1-205-220-9545 Rev. 04/2015 Blue Cross and Blue Shield of...
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What is preferred physician?
Preferred physician is a healthcare provider chosen by an employee to receive treatment in case of a work-related injury or illness.
Who is required to file preferred physician?
Employers are required to file preferred physician information with the workers' compensation insurance carrier.
How to fill out preferred physician?
Preferred physician forms can typically be filled out online or by submitting a paper form to the insurance carrier.
What is the purpose of preferred physician?
The purpose of preferred physician is to ensure that injured employees receive prompt and appropriate medical care from a healthcare provider of their choice.
What information must be reported on preferred physician?
Preferred physician information should include the name, address, contact details, and specialty of the chosen healthcare provider.
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