Get Vacorp Rx First Fill Form - Apsva

This guide provides clear and structured instructions for filling out the VACORP Rx First Fill Form - Apsva online. By following these steps, users can ensure a smooth submission process for their workers' compensation prescriptions.

Follow the steps to effectively complete the form.

1. Click ‘Get Form’ button to access the VACORP Rx First Fill Form - Apsva for online completion.
2. Enter the injured worker’s first name, middle initial, and last name in the designated fields.
3. Provide the injured worker’s street address or PO Box, as well as the city, state, and ZIP code in the appropriate sections.
4. Fill in the employer's name in the designated field to associate the form with the correct employer.
5. Input the bin number '003858' in the specified section to facilitate processing.
6. Enter the processor control number 'A4' in the appropriate field.
7. Provide the group number as it appears on the form to ensure accurate claims processing.
8. Input the injured worker’s nine-digit ID number as required.
9. Enter the date of injury in the format YYYYMMDD in the designated DOI field.
10. Review all entered information for accuracy, then save your changes. You may choose to download, print, or share the form as needed.

Complete the VACORP Rx First Fill Form - Apsva online to ensure timely processing of your prescription reimbursement.