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The Workers' Compensation (WC) Carrier page allows you to add a WC carrier to a case. You can only add one carrier to a case. Any additional carriers must be entered on the Case Notes page. Fields noted with a 1 on the application are required.
Worker's Compensation (WC) Carrier Data Elements
| Element | Description |
| Insurer Name | Enter the carrier company name. |
| Address Line 1 | Enter the first line of the carrier’s mailing address. |
| Address Line 2 | Enter the second line of the carrier’s mailing address. Optional. |
| City | Enter the city where the carrier is located. |
| State | Select the state where the carrier is located from the dropdown list. |
| Zip Code | Enter the carrier’s 5-digit zip code. The Zip+4 field is optional. |
| Phone | Enter the carrier’s phone number. The extension field is optional. |
| Fax | Enter the carrier’s fax number. Optional. |
| Enter the carrier’s email address. Optional. | |
| Re-enter Email | Re-enter the carrier’s email address. The address must be manually entered; it cannot be copied and pasted. Note: This field is required if an email address is entered in the previous field. |
| Policy Number | Enter the claimant’s policy number with the WC carrier. Note: Required if a Claim Number is not entered. Do NOT enter a policy number and claim number. |
| Claim Number | Enter the claimant’s claim number with the WC carrier. Note: Required if a Policy Number is not entered. Do not enter a policy number and claim number. |
| Tax ID Number (TIN) | Enter the carrier’s 9-digit Tax Identification Number. Optional. |
| RX PCN | Enter the Pharmacy Benefit Processor Control Number. Optional. |
| RX BIN | Enter the Pharmacy Benefit International Identification Number. Optional. |
Click Previous to return to the previous page.
Click Next to save all information and proceed to the next page.
Click Case Summary to view a synopsis of the case information entered.
For new cases and cases in Work-In-Progress (WIP) status:
- Click Save Work-In-Progress to save all information entered up to this point. You can return to the WCMSAP at a later time to complete the case creation process.
- Click the Cancel Case Creation button to delete all information entered and cancel out of the case creation process.
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