Transcription of SEND BILLS TO: Sedgwick CMS P.O. Box 14482 Fax: …
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SEND BILLS TO: Sedgwick CMS P.O. Box 14482 Fax: …
SEND BILLS TO: Sedgwick CMS Box 14482 Lexington, KY 40512 Fax: 904-419-5390 Instructions to Provider: In compliance with state statutes, please try to: Utilize the FIRST HEALTH NETWORK group of providers, when possible First Health Network website is Health Plan Members Login: strat Supply necessary reports when an employee is seen to the appropriate Sedgwick examiner. Contact Sedgwick for: Any referral to a specialist All hospitalizations All surgeries, inpatient or outpatient Any treatment plan changes Contact Your Assigned Sedgwick Examiner at: 866-272-1081. Please fax medical reports to Sedgwick at 904-419-5390. Employee Name: _____ Job Title: _____ Employer Name: _____ Authorized by: _____ Examiner s Location: _____Jacksonville, FL_____ Injury Date: _____ Body Part Injured: _____ ATTENTION EMPLOYEE AND PROVIDER: THIS SHEET DOES NOT GUARANTEE PAYMENT.
Title: Microsoft Word - Employee Information Sheet - Jacksonville, FL Branch.doc Author: latrefny Created Date: 2/20/2008 10:11:09 AM
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