Transcript Slide 1

Department of Education
Division of Vocational Rehabilitation
Bureau of Rehabilitation & Reemployment Services
Carrier Training Module
CARRIER TRAINING MODULE
Contents of Training Module – Page 1of 3
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Purpose
Reemployment Services Audits
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Statutory Authority
Statutory Intent
Audit Items
Reemployment Status Review (DWC-22)
Voluntarily Provided Services
Reemployment Services Billing Form (DWC-21)
Referrals to the Department
Notification of Department Services
Audit Checklist
CARRIER TRAINING MODULE
Contents of Training Module – Page 2 of 3
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Qualified Rehabilitation Provider Requirements
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Statutory and Rule Citations
BRRS Roles Regarding QRPs
Non-Qualified Rehabilitation Providers
Allowable QRP Services
Use of Interns
Non-QRPs Working Under a Listed QRP’s Number
Use of Interpreters
QRP Status Revocation
Advertising for QRPs
CARRIER TRAINING MODULE
Contents of Training Module – Page 3 of 3
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Qualified Rehabilitation Provider Requirements (Cont.)
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Managed Care Referrals
AHCA Internal/External Case Management Requirements
BRRS Case Management
Licensed Practical Nurses
Meeting QRP Workshop Requirements
Automated E-mails
Educational and Technical Assistance
Contacts
CARRIER TRAINING MODULE
REEMPLOYMENT SERVICES AUDITS
CARRIER TRAINING MODULE
Purpose
The purpose of this training module is to provide the
information necessary to ensure that carriers and
qualified rehabilitation providers will be in
compliance with the provisions of Section 440.491,
Florida Statutes, and Rule Chapter 6A-22, Florida
Administrative Code.
CARRIER TRAINING MODULE
Statutory Authority
On an on-going basis, the Bureau audits the performance of
all Florida Workers’ Compensation insurance carriers and
servicing agents for compliance with the statutory intent and
requirements under s. 440.491, Florida Statutes, and Rule 6A22, Florida Administrative Code.
CARRIER TRAINING MODULE
Statutory Intent
The statutory intent is defined in subsection 440.491 (2),
Florida Statutes, as
“…to implement a systematic review by carriers of the
factors that are predictive of longer-term disability and to
encourage the provision of medical care coordination and
reemployment services that are necessary to assist the
employee in returning to work as soon as is medically
feasible.”
CARRIER TRAINING MODULE
Statutory Intent: Three Main Points
(1) Assist injured workers with returning to work as soon as
medically feasible;
(2) Perform a systematic review of factors that are predictive of
longer-term disability; and,
(3) Encourage the provision of Medical Care Coordination and
Reemployment Services.
CARRIER TRAINING MODULE
Audit Items
Carrier files are audited to determine compliance with
statutory and rules requirements in the following areas:
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Reemployment Status Reviews (DWC-22’s)
Voluntary services and use of Qualified
Rehabilitation Providers (DWC-21’s)
Referrals of IE’s to the Department
Notification of Department Services (DWC-23)
CARRIER TRAINING MODULE
Reemployment Status Reviews (DWC-22)
The Reemployment Status Review, reported by the
carrier to the Department on Form DWC-22,
determines whether the worker is likely to return to
work.
CARRIER TRAINING MODULE
Reemployment Status Reviews (DWC-22)
When are Reemployment Status Reviews performed?
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60 days after the date of accident when the injured employee
 remains unemployed, and
 is receiving Temporary Total Disability (TTD), Temporary
Partial Disability (TPD), or Wage Loss benefits, and
 is not receiving Medical Care Coordination (MCC) or
Reemployment Services (RES) as defined in s. 440.491,
Florida Statutes.
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Repeated every 90 days as specified when above criteria are met.
CARRIER TRAINING MODULE
Reemployment Status Reviews (DWC-22)
Important Note:
Services provided under a Managed Care Contract pursuant
to Section 440.134, Florida Statutes, and Rule Chapter 59A23.002(7), Florida Administrative Code, do NOT exempt the
carrier from its responsibilities under Section 440.491,
Florida Statutes, including the completion and filing of the
Reemployment Status Review.
CARRIER TRAINING MODULE
Reemployment Status Reviews (DWC-22)
Common DWC-22 Errors
Block #2 - Invalid SSN
Block #3 - No Date of Accident
Block #5 - No Date of Review
Block #7 - No Carrier/TPA Address
Block #8 - No Carrier Code
Block #9 - No Third Party Administrator (TPA) Code
Block #10 - Incomplete and/or No Explanation
***Illegible
***Incorrect Form (use form dated 5/5/04)
***No Carrier Date Stamp
Reemployment Status Review (Form DWC-22)
Date Stamp
#2
#5
#8
#7
#9
#10
Use Form Dated 05/05/04
#3
CARRIER TRAINING MODULE
Reemployment Status Review (Electronic DWC-22)
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Rule 6A-22.003 (2) , F.A.C., which requires electronic
submission of the form DWC-22, was revised on May 7,
2009.
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Mandatory electronic submission of form DWC-22 becomes
effective November 7, 2010.
CARRIER TRAINING MODULE
Reemployment Status Review (Electronic DWC-22)
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The carrier shall complete an electronic Form DWC-22
within 15 days of the reporting requirement deadlines set
forth in Section 440.491(3)(a), F.S. (Refer to slide 9).
 The carrier shall retain a copy in the carrier’s file.
 Within 15 days of completion, the carrier shall submit the
electronic form DWC-22 to the Department’s website at
www.rehabworks.org/brrs or http://wc-returntoworkvr.doe.st.fl.us/rehabforms .
CARRIER TRAINING MODULE
Reemployment Status Review (Electronic DWC-22)
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The electronic form DWC-22 shall comply with the File
Layout for Electronic Submission. (See the “Electronic Forms
Reporting System User’s Manual” on the BRRS website.)
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BRRS designed the electronic system with built-in edits to
assist carriers or TPAs determine if the information entered
on a DWC-22 form would be considered valid by the BRRS
before the form is submitted to the Department. The system
will not accept invalid data entries.
CARRIER TRAINING MODULE
Reemployment Status Review (Electronic DWC-22)
Access to the Electronic Forms Reporting System
 The BRRS must grant system access to a user before the
system can be used for electronic submission of form
DWC-22.
 To gain access to the system, a user must go to the
“Electronic Forms Reporting System User’s Manual” on
the BRRS website to print out a User Request Form.
Complete the form and submit it to the BRRS. The BRRS
will create a user account and assign a user ID and
password.
CARRIER TRAINING MODULE
Reemployment Status Review (Electronic DWC-22)
Restricted Use Policy
 The design of the Electronic Forms Reporting System
limits form access to only those authorized users.
 Carriers and TPAs will only be able to view those forms
that list their Division of Workers’ Compensation assigned
3 or 4-digit carrier or TPA code under the field labeled
“Workers Comp ID.”
CARRIER TRAINING MODULE
Voluntarily Provided Services
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Voluntary services include the following services:
 Medical Care Coordination (MCC)
 Reemployment Assessments (REA)
 Reemployment Services (RES)
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For MCC, REA, and RES, carriers must use Qualified
Rehabilitation Providers (QRPs) listed in the directory.
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For RES, carriers must prepare a reemployment plan that
is approved by both the carrier and the injured employee.
CARRIER TRAINING MODULE
Reemployment Services Billing Form (DWC-21)
Reporting of Voluntary Services
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Voluntary services are reported on Form DWC-21, dated
05/05/2004.
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Form DWC-21 should be properly completed and
submitted to the Department.
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Form DWC-21 should be accompanied by a report in the
carrier’s file.
CARRIER TRAINING MODULE
Reemployment Services Billing Form (DWC-21)
Common DWC-21 Errors
Block #2 - Invalid SSN
Block #3 - No Date of Accident
Block #4 - No Date of Referral
Block #6 - No Carrier/TPA Address or Carrier/TPA Code
Block #10 - No Provider Name/Provider Number
Block #14 - No Dates of Service
Block #15 - Invalid Service Codes (MCC, RES, & REA only)
Block #20 - No Date Received
Block #21 - No Date Reimbursed
Block #23 - No Total Amount Reimbursed
***Illegible
***Incorrect form (use form dated 5/5/04)
***No Carrier Date Stamp
Reemployment Services Billing Form (DWC-21)
Date Stamp
#2
#3
#4
#7
#6
#10
#14
#20
#10
#15
#21
#23
Use Form Dated 05/05/04
CARRIER TRAINING MODULE
Reemployment Services Billing Form (Electronic DWC-21)
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Rule 6A-22.003 (2) , F.A.C., which requires electronic
submission of the form DWC-21, was revised on May 7,
2009.
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Mandatory electronic submission of form DWC-21 becomes
effective November 7, 2010.
CARRIER TRAINING MODULE
Reemployment Services Billing Form (Electronic DWC-21)
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A qualified rehabilitation provider (QRP) providing either
employer or carrier sponsored reemployment services,
reemployment assessments, or medical care coordination
shall report on electronic form DWC-21 only those services
provided by or through the authorized QRP.
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The QRP shall submit a properly completed electronic form
DWC-21 listing the specific service(s) provided, utilizing
only valid service codes and descriptors for those direct
services rendered to the injured employee.
CARRIER TRAINING MODULE
Reemployment Services Billing Form (Electronic DWC-21)
Initial, Interim, and Final Form Submissions
 The initial electronic form DWC-21 shall be submitted to
the Department within thirty (30) days of the contract
approval date for Department sponsored services or to the
employer or carrier within thirty (30) days of the date of
the referral for employer or carrier sponsored services.
 An interim electronic form DWC-21 shall be submitted at
thirty (30) day intervals thereafter during which the
authorized services are provided. The DWC-21 should not
be filed if services are not provided within any thirty (30)
day period.
CARRIER TRAINING MODULE
Reemployment Services Billing Form (Electronic DWC-21)
Initial, Interim, and Final Form Submissions (cont.)
 A final electronic form DWC-21 shall be submitted within
thirty (30) days of the date of the last service provided.
 Close a file and submit a final electronic form DWC-21
when attorney involvement interferes with the provision
of direct services.
CARRIER TRAINING MODULE
Reemployment Services Billing Form (Electronic DWC-21)
The Employer or Carrier Shall:
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Ensure that the information required in this rule is provided on
the DWC-21 prior to payment and filing of the electronic
DWC-21 with the Department; and
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Approve or deny the provision of services recommended as
part of an individualized written rehabilitation program within
15 calendar days of receipt of the same; and
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Pay or deny DWC-21 bills within 45 calendar days after receipt
of a bill for services provided to an injured employee; and
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Complete blocks 20, 21 and 23 on every electronic DWC-21
filed with the Department.
CARRIER TRAINING MODULE
Reemployment Services Billing Form (Electronic DWC-21)
The Employer or Carrier Shall (Cont.):
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File the electronic DWC-21 with the Department of Education on the
Department’s website at www.rehabworks.org/brrs or http://wcreturntowork-vr.doe.st.fl.us/rehabforms within thirty (30) days after the
full or partial payment of form DWC-21.
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The electronic DWC-21 shall comply with the File Layout for Electronic
Submission, Revision C Record Length: 1200 Header Record Layout for
DWC-21 as incorporated by reference in Rule 6A-22.011, F.A.C. (See the
“Electronic Forms Reporting System User’s Manual” on the BRRS website .)
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BRRS designed the electronic system with built-in edits to assist carriers or
TPAs determine if the information entered on a DWC-22 form would be
considered valid by the BRRS before the form is submitted to the Department.
The system will not accept invalid data entries.
CARRIER TRAINING MODULE
Referrals to the Department
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Injured employees may be referred to the Department at any
time using Form DWC-23 (Request for Screening).
Referrals to the Department are required when
 The QRP determines training and education is necessary,
and
 180 days after the referral date for RES or when the
injured worker receives $2,500.00 in RES.
It is important that the carrier sign the DWC-23 before
submitting it to the Department.
Request for Screening Form (DWC-23)
CARRIER TRAINING MODULE
Notification of Department Services
The carrier is required to notify the injured
employee in writing of the availability of
Department services 180 days post injury if
the IE is unemployed and receiving
compensation.
CARRIER TRAINING MODULE
Audit Checklist
The BRRS Audit Team examines case files to ascertain
compliance with the statute and rules by asking the following
questions:
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What are the dates, type, and amount of indemnity benefits
paid?
Is the Injured Employee (IE) working?
Was there a referral for MCC or RES?
What are the dates of service on Form DWC-21?
Is a copy of the correspondence present?
Are Forms DWC-21 present if required?
Are Forms DWC-22 present if required?
CARRIER TRAINING MODULE
Audit Checklist (Cont.)
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Is Form DWC-23 present if required?
Are accompanying reports to the Electronic DWC-21
present?
Are valid Qualified Rehabilitation Providers used?
Is an Individualized Reemployment Plan present if required?
Are payments timely?
Are Form submissions timely?
Are Form submissions correct?
CARRIER TRAINING MODULE
QUALIFIED REHABILITATION
PROVIDER (QRP) REQUIREMENTS
CARRIER TRAINING MODULE
Statutory and Rule Citations
The qualifications and requirements for Qualified
Rehabilitation Providers (QRPs) are delineated in the
following statute and rule:
 Section 440.491(7) (d), Florida Statutes
 Rule 6A-22.002, Florida Administrative Code
CARRIER TRAINING MODULE
BRRS Roles Regarding QRPs
The BRRS is responsible for the following activities:
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Approving QRPs who submit proof of meeting minimum
requirements established by Rule 6A-22.002, Florida
Administrative Code;
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Investigating and maintaining a directory listing of QRPs,
facilities, and agencies;
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Establishing by rule the minimum qualifications and/or
credentials to be eligible for listing in the directory;
CARRIER TRAINING MODULE
BRRS Roles Regarding QRPs (Cont.)
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Monitoring and evaluating each rehabilitation service
provider and agency to ensure compliance with minimum
qualifications and credentials;
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Imposing a biennial application fee of $25 for each listing in
the directory; and,
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Providing Bureau-sponsored QRP Workshops (face-to-face
and web-based).
CARRIER TRAINING MODULE
Non-Qualified Rehabilitation Providers
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Individuals who are not listed in the directory can not provide
medical care coordination, reemployment services,
reemployment assessments, or vocational evaluations.
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Individuals who are not QRPs can not provide expert
testimony on rehabilitation issues in Florida.
CARRIER TRAINING MODULE
Allowable QRP Services
Section 440.491, Florida Statutes, specifies the services that a
QRP can provide:
 Medical Care Coordination
 Reemployment Services
 Reemployment Assessments
 Vocational Evaluations by a Certified Vocational
Evaluator (CVE)
CARRIER TRAINING MODULE
Use of Interns
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There are currently no provisions that allow for the use of
interns.
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Former Rule 38F-8.039, Florida Administrative Code, which
became effective March 26, 1984, authorized the use of
interns.
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However, Rule 38F-8.039, Florida Administrative Code,
was repealed effective 11/12/95, and the use of interns is no
longer allowed.
CARRIER TRAINING MODULE
Non-QRPs Working Under a Listed QRP’s Number
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Individuals who have not met the requirements to become a
QRP and have not been assigned a Florida WC Provider
Number should not be providing services under any
circumstances.
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Any use of a non-QRP is in violation of Rule 6A-22, Florida
Administrative Code and s. 440.491, Florida Statutes.
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A QRP who reports and bills for services conducted by a nonQRP will have his/her QRP status revoked and be reported to
the ethics committee of the credentialing board.
CARRIER TRAINING MODULE
Use of Interpreters
Although services may require the use of an interpreter, “all
services provided by a carrier or a rehabilitation company
under Section 440.491, Florida Statutes, shall be provided
only by an individual who is a qualified rehabilitation
provider or a facility that is a qualified rehabilitation
provider.”
CARRIER TRAINING MODULE
QRP Status Revocation
Rule 6A-22.002(4), Florida Administrative Code, allows the
Bureau to revoke approval of a qualified rehabilitation provider,
company, or facility for a period of six (6) months for one or
more of the following reasons:
 Revocation of credentials or certification by the applicable
certification or credentialing board,
 Misrepresentation of credentials or certification, or
 Allowing a non-qualified rehabilitation provider to
fraudulently report and bill for services using an individual’s,
company’s, or facility’s WC Provider Number.
CARRIER TRAINING MODULE
Advertising for QRPs
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Advertisements recruiting rehabilitation providers that state
“QRP Eligibility Required” are misleading. Individuals who
have not been issued a WC Provider Number are ineligible
to provide services for injured workers in Florida.
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The BRRS will not grant waivers for any reason.
CARRIER TRAINING MODULE
Managed Care Referrals
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Managed Care case referrals are referred under a Managed
Care Arrangement approved by the Agency for Health Care
Administration (AHCA).
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Cases referred other than those administered by a Managed
Care Arrangement come under the purview of reemployment
services in accordance with s. 440.491, Florida Statutes.
CARRIER TRAINING MODULE
AHCA Internal/External Case Management Requirements
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AHCA rules under Chapter 59A-23.002(7),
Florida Administrative Code, define “external case
management” as face-to-face medical care coordination
performed by a QRP pursuant to s.440.491, Florida Statutes.
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AHCA rules under Chapter 59A-23.002(10), Florida
Administrative Code, do not state that individuals performing
“internal case management” have to meet QRP requirements
pursuant to s.440.491, Florida Statutes.
CARRIER TRAINING MODULE
BRRS Case Management
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Case management under the context of medical care
coordination or other reemployment services defined in
s.440.491, Florida Statutes, and Rule 6A-22, Florida
Administrative Code, must be performed by a QRP.
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All case management services must be reported and billed
using Form DWC-21 (Reemployment Services Billing Form).
CARRIER TRAINING MODULE
Licensed Practical Nurses
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A licensed Practical Nurse does not qualify as a QRP.
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Only a nurse licensed in the state of Florida as a registered
professional nurse and who provides proof of one of the
accepted professional credentials may apply to become a
QRP and be listed in the directory.
CARRIER TRAINING MODULE
Meeting QRP Workshop Requirements
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Individuals applying to become a QRP must provide proof of
attendance at a Bureau provided qualified rehabilitation
provider workshop.
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Workshops are offered through the BRRS district offices or
via the internet.
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Effective November 1, 2004, the QRP Workshop requirement
can be met on-line at www.rehabworks.org/brrs.
CARRIER TRAINING MODULE
Automated E-mails
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Automated e-mails are sent to QRPs regarding their QRP
directory status, including the following letters:
 Expiring certification
 Expiring credentials
 Renewal
 Suspension
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Recipients should click on the hyperlink provided in the e-mail
to acknowledge receipt of the automated e-mail; otherwise,
BRRS will need to mail a paper copy.
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Rule 6A-22.002(4), F.A.C., requires QRPs to provide a business
e-mail address that must be maintained during the period that the
applicant is listed in the directory.
CARRIER TRAINING MODULE
ASSISTANCE AND CONTACTS
CARRIER TRAINING MODULE
Educational and Technical Assistance
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The Bureau of Rehabilitation and Reemployment Services
staff is available to provide guidance, direction, and technical
assistance regarding the QRP provider qualification
requirements under Section 440.491, Florida Statutes, and
Rule 6A-22, Florida Administrative Code.
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All carriers and employers must comply with the applicable
rules and statutes regarding rehabilitation provider
requirements without exception.
CARRIER TRAINING MODULE
Contacts

Reginald Watkins (850) 245-3470
[email protected]

Betty Gibson (850) 245-3470 or
[email protected]
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Paul Lincolnhol (850) 245-3470 or
[email protected]
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Cheryl Farner (850) 245-3470 or
[email protected]
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Shone Beckwith (850) 245-3470 or
[email protected]
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BRRS website: www.rehabworks.org/brrs