Workers’ Compensation Documents

Title Link to File
Payment Activity Report 14-0147 14-0147par.pdf
Partial Commutation 14-0017 14-0017-PartCommPgs1-2.pdf
Original Notice: Vocational Rehabilitation Program Benefit 14-0009 14-0009.pdf
Original Notice: Independent Medical Examination 14-0007 14-0007imefillable.pdf
Original Notice: Application for Alternate Medical Care (85.27) 14-0011 14-0011altcarefillable.pdf
Original Notice and Petition Form No. 100 (Fillable) 14-0005 form100fillable.pdf
Original Notice and Petition Form No. 100 14-0005 14-0005 form100fillable.pdf
Order Form for Iowa EDI Release 2 Implementation Guide ediorderform.pdf
Nonelection of Coverage Form 14-0175nonelection.pdf
New R3.1 Implementation Guide, Transition Timeline Summary and Test Plan Now Available Iowa EDI R3.1 Updates Claims Implementation Guide and Information V1.0 (4-9-18) (1).pdf
Member Report Regarding the AMA Guides, Sixth Edition by John Kuhnlein, D.O. kuhnleinreport.pdf
Medical Report Transmittal Form 14-0141 14-0141medtransmit.pdf
Mark D. Sloan v Mark D. Sloan, D.D.S., P.C., d/b/a Sloan Family Dentistry, P.C. SLOAN,MARK D. Partial Commutation Ruling.pdf
March 2002 Update Instructions march2002updateinstructions.pdf
March 2002 Iowa Release 2 Implementation Guide march2002ediguide.pdf
Letter Regarding AMA Guides, Psychiatric Impairment by James L. Gallagher, M.D. jamesgallagher.pdf
Law/Ratebook Order Form 2016-2017 LawBookOrderForm16-17.pdf
John Deere Declaratory Order Regarding Profit Sharing Bonus and Continuous Improvement Pay Plan JOHN DEERE Declaratory Order Regarding Profit Sharing Bonus and Continuous Improvement Pay Plan.pdf
Issues with Chapter 14, AMA Guides, Sixth Edition - Mental and Behavioral Disorders by John Brooke, Ph.D. johnbrooke.pdf
Iowa Match Data Table March 17, 2000 march2002matchtable.pdf
Iowa Element Requirement Table ertmarch2002.pdf
Iowa Electronic Data Interchange Claim and Reporting Compliance Handbook July 2001 July2001IowaEDIComplianceClaimsHandbook.pdf
Iowa Edit Matrix Table dec2001emtable.pdf
Iowa Conditional Table ictmarch2002.pdf
Iowa Claims Release 3.1 EDI Announcement Iowa Claims Release 3.1 EDI Announcement 11-8-17 (1).pdf