Get Bwc C19 Form

Filling out the Bwc C19 Form online can seem daunting, but with the right guidance, you can complete it effortlessly. This guide will provide you with detailed, step-by-step instructions on how to fill out this important document correctly.

Follow the steps to complete the Bwc C19 Form online with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editing platform.
2. Indicate the bill type by checking the appropriate box. This section specifies the nature of the invoice and must be completed accurately.
3. Provide the injured worker's name in the designated field, ensuring to fill in the last name, first name, and middle initial.
4. Enter the date of the injury. This information is crucial for the processing of the claim.
5. Fill in the injured worker's address, including the street or P.O. Box, city, state, and ZIP code.
6. If applicable, include the referring physician's name and provider number in the respective fields.
7. Complete the patient account number and prior authorization number if it is relevant to the case.
8. Fill out the provider information section by entering the provider name and number.
9. Tick the checkbox if the total payment is to be made to the injured worker.
10. Detail the services provided by entering the service date, procedure codes, and a description of the service.
11. Complete the charges and units of service as required, ensuring accuracy.
12. Affix the provider's signature and date the form to validate the invoice.
13. Remember to fill in your name, address, and contact number in the designated area at the end of the form.
14. Review all entered information for accuracy before submitting or saving changes.
15. Once completed, you can download, print, or share the filled form as needed.

Take charge of your documentation needs by completing the Bwc C19 Form online today.