Get State Of Nevada Department Of Business And Industry Division Of ...

Filling out the State Of Nevada Department Of Business And Industry Division Of Industrial Relations form is essential for third-party administrators to provide historical data as required by law. This guide will walk you through each step of the process in a clear and supportive manner.

Follow the steps to complete and submit your form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your Third-Party Administrator (TPA) identification information. Fill in the TPA name, street address, city, state, and zip code. Ensure all information is accurate.
3. Next, provide the Versa license number associated with your TPA. This number is crucial for identification and record-keeping.
4. Proceed to the TPA historical data section. For each fiscal year (FY06 through FY10), input the number of claims that were accepted, denied, and reopened. Sum these amounts to calculate the total claims handled for each fiscal year.
5. Once you have completed the historical data section, move to the 'Completed By' section. Here, input your name, company affiliation, telephone number, and title.
6. Provide your email address and date of completion. Note that a signature is not required if you are submitting via email.
7. After filling out all necessary fields, review your entries for accuracy. Make any necessary corrections.
8. Once you are satisfied with the information entered, you can save your changes, download the completed form, or share it as needed.

Take the next step and complete your document online to ensure compliance with state requirements.