| Information CHS Needs from You | By When | Who to Contact | How to Contact | Necessary Documentation | Result of Communication |
|---|---|---|---|---|---|
| CHS may
receive first notice of injury from the employer, injured worker or provider
by calling CHS INJURY REPORTING LINE 888-247-4800 |
|||||
| First Report of Injury (FROI) | Within 24 hours of patient visit | CHS Intake | 888-247-4800 FAX 614-718-9870 |
FROI Form or call with Injury Information/ ICD-9 Code | Expedite BWC Claim Notification and Processing |
| Doctor's Report and Treatment Plan | Within 24-48 hours of patient visit | CHS Case Management | 888-247-7799 FAX 614-718-9870 |
See CHS Doctor's and Treatment Plan Form | Proper diagnosis and treatment guideline is established |
| ER, Initial, Office Notes and copies of all reports | Within 48 hours of patient visit | CHS Case Management | 888-247-7799 FAX 614-718-9870 |
Additional reporting of medical condition may be necessary | CHS Case Management continues to monitor patient and communicate information to BWC and employer |
| A request for services other than routine lab and x-rays | Prior to services being rendered | CHS Case Management | 888-247-7799 FAX 614-718-9870 |
You may call for verbal authorization but written request will be required | Based on medical necessity, authorization may or may not be granted |
| All bills for service | Within 30 days of service | CHS Billing Department | Mail to: PO BOX 1040 Dublin, OH 43017 |
UB 92 or HCFA 1500 | CHS will reimburse according to the BWC fee schedule |