- Contact a preferred urgent care facility by telephone prior to sending the injured worker.
- Inform the urgent care that you have an injured worker coming and that Benchmark Administrators is the claims administrator.
- If a worker is seriously injured and needs immediate care or is transported by ambulance, the employer should have a co-worker or supervisor go with the injured worker to assist the injured worker with any insurance related information that the medical provider may require.
- If possible, the injured worker must return to your office or job site after seeing the doctor and give you the doctor’s signed return to work slip or disability slip.
- It is necessary that the employer fill out the required Form ICA 04-0101 and notify us immediately. Please forward the return to work/disability slip from the doctor to Benchmark Administrators as soon as possible.
Arizona
When an employee is injured on the job, proceed with the following:
Additional Forms
Please Send the Form ICA 04-0101, Medical Slip and Prescription Bills to:
P.O. Box 46350
Las Vegas, NV 89114
Telephone: (208) 848-2020
Toll free (800) 362- 5198
Fax (208) 853-4076
Medical Billing
Medical Bills Can Be Mailed To:
P.O. Box 14365
Lexington, KY 40512
Process medical bills online by signing up with E-Billing Benefits
Western Integrated Care, on behalf of Benchmark Administrators, Payer ID is LV191.
24-HOUR CLAIM REPORTING HOTLINE: 1-866-337-0891
Customer Service Representatives are on call 24 hours per day to assist you. Please have the injured worker's information available as well as the accident description.