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Employer Designated Provider Listing
for Correlated Injuries/Illnesses (Students)
If you become injured on the job:
1. Report your injury to Susan Torres, Benefits Analyst in Human Resources
2. Select
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How to fill out employer designated provider listing
How to fill out employer designated provider listing
01
Obtain the employer designated provider listing form from your employer.
02
Read the instructions carefully to understand the specific requirements and criteria for the provider listing.
03
Gather all the necessary information about the healthcare providers you wish to include in the listing.
04
Fill out the form accurately and completely, providing all the requested details about each provider.
05
Double-check the form for any errors or missing information before submitting it.
06
Submit the completed form to your employer according to their specified submission method.
07
Wait for confirmation or further instructions from your employer regarding the status of your provider listing.
Who needs employer designated provider listing?
01
Employer designated provider listing is needed by employees who have health insurance coverage through their employer.
02
It allows employees to access a list of approved healthcare providers within their insurance network.
03
By using the designated providers, employees can receive the maximum benefits and coverage provided by their health insurance plan.
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What is employer designated provider listing?
Employer designated provider listing is a list of healthcare providers chosen by the employer to treat injured employees under workers' compensation.
Who is required to file employer designated provider listing?
Employers are required to file employer designated provider listing.
How to fill out employer designated provider listing?
Employers can fill out the employer designated provider listing by entering the required information for each designated provider.
What is the purpose of employer designated provider listing?
The purpose of employer designated provider listing is to ensure that injured employees have access to designated healthcare providers for treatment under workers' compensation.
What information must be reported on employer designated provider listing?
The employer designated provider listing must include the names, specialties, contact information, and locations of the designated healthcare providers.
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