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Utah

When an employee is injured on the job, proceed with the following:

  1. 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.
    • Advise the urgent care you require a mandatory drug test per the insurance company.
  2. 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.
  3. It is necessary that the employer fill out the required Form 122 and notify us immediately. Please forward the return to work/disability slip from the doctor to Benchmark Administrators as soon as possible.

Required State Forms

Provo - Form 122

Additional Forms

Medical Provider Options:

FirstMed
441 S. Redwood Road
Salt Lake City, UT 84104
801-973-2588

Intermountain WorkMed
1685 W. 2200 S.
Salt Lake City, UT 84119
801-972-8850

St. Mark’s Hospital
1160 E 3900 S #2000
Salt Lake City, UT 84124
801-266-3418

U of U Hospital
50 Medical Drive
Salt Lake City, UT 84132
801-581-2121

Timpanogas Regional Hospital
750 W 800 N
Orem, UT 84057
801-714-6000

Mountain View Hospital
1000 E 100 N
Payson, UT 84651
801-465-7000

Correspondence & Prescription Billing

Send Form 122 to:

Benchmark Administrators
PO Box 46350
Las Vegas, NV 89114
Telephone: (866) 221-3110
Toll Free: (800) 362-5198
Fax: (801) 623-6035

Medical Billing

Medical bills should be mailed to:

P.O. Box 14365
Lexington, KY 40512

Process medical bills electronically through the following ebilling options:

Western Integrated Care (WIC), on behalf of BMA payer ID is LV191 via ebilling provider Data Dimensions or J4466 or J4005 via ebilling provider JOPARI.

If providers are interested in enrollment or have questions about submitting via Data Dimensions or Jopari Solutions, please reach out to the following support resources:

Data Dimensions: www.datadimensions.com/support

Jopari Solutions: www.jopari.com/ebill-enrollment or www.jopari.com/contact-us

24-Hour Claim Reporting Hotline:

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.