Get Utilization Review Notification C 35

Filling out the Utilization Review Notification C 35 is an important step in the workers' compensation process. This guide will provide clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to fill out the form effectively.

1. Click 'Get Form' button to obtain the form and open it in your preferred online editor.
2. In the employee information section, fill in the state file number, date of injury, and social security number. Provide the name of the claimant clearly.
3. In the employer information section, enter the FEIN (Federal Employer Identification Number), the employer's name, and the employer's address details including street, city, state, and zip code.
4. Move to the insurer information section and complete the insurer's name, insurer claim number, and policy number fields.
5. For the utilization review information, indicate which condition applies by checking the applicable threshold(s), such as outpatient cases or inpatient hospital admission. Be sure to provide explanations for 'other' if necessary.
6. Complete the details of the utilization review provider, including their name, Tennessee registration number, address, phone number, and contact person's name.
7. Record the date when the utilization review was initiated in the designated space.
8. Use the comments section to provide any additional information necessary for the review process.
9. Once all fields are filled out, review your information for accuracy. You can then save changes, download, print, or share the form as needed.

Complete your Utilization Review Notification C 35 online today!