OXFORD-Risk Management: Employee Incident Report

Claim Processing - Employee Incident Report:

Incident Reports must be faxed within 24 hours of the incident.
Do not wait to send the report with Friday's claim report.
Fill out forms completely and accurately and print them.
Administrators must sign Incident Reports before sending them to Risk Management.
All unsigned forms will be returned and must be resubmitted.
Maling instructions are listed under item #6 of Claims Processing: Instructions Page

INVESTIGATING FACILITY
Today's Date:
Investigation By:
Investigating Facility Name:
Facility Phone Number:
Address:
City:
State:		Zip Code: