Authorization Number : 855-0789
Agency Series No. : HPP-01
Status : Active
Agency Web Link :
Agency : BWC
Confidential Description : The listing contains the claimant's claim number, claimant name, address, social security number, amounts charged and amounts paid.
Division : BWCMEDI
Vital Description :
Section : BWCMEDIMMMS
Record Title : Provider History List
Revision : 1
Record Description : The Provider History List contains a listing of all the patients of a provider and a detailed list of the patients treatment. The listing contains provider number, claimant number, claimant name, address, social security number, treatment type, date of treatment, amounts charged and amounts paid.