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Named User Manual

1. fiti Emplopels Fust pont of Accident he leu nar Vagma Waker Compercaten Coir i h Resor los ing raat katalon 1000 OH Drive Pchmand YA 21220 wul thes hha a Sec motrechorron fhe cerezo of fier fann MAC Emal Adidhesan ta send submission notification Iresarer clean mante THIS SECTION j Si REDDI w Caution li you close a new EAR without saving or submitting it all of the data entered will be lost E Note See the Saving an EAR section for more information Avizent 2009 e800 777 4283 e www AvizentRisk com Page 21 Printing an EAR Printing produces an electronic copy of the EAR which can then be printed in hard copy You can print EARs from several different areas Open EAR When you are reviewing an EAR a Print button is available in the EFROI toolbar File Edit New Document AVIZENT June 20 2008 Welcome FOCINC yaear Employers Accident Report formerl Employer s First Report of Accident Validation Results Virginia Workers Compensation Commission 1000 OMY Drive Richmond YA 23220 AE ot fe reverses E For Review Folder lIn the Documents for you to review table a Print button is available at the bottom of the Content pane ff Yisual Liquid Web 2 2 File Edit yi New Document Standby Preferences Documents for you to review AVIZENT a Creation Date Document Version Id Subject Document Name b 6 17 2008 4 36 PM 12 6 17 2008 4 36 14 PM
2. JE AVIZENT Frank Gates Service Co Attenta 5000 Bradenton Ave e Dublin OH 43017 USA Voice 800 777 4283 e Fax 614 791 7695 Email info AvizentRisk com Avizent 2008 RISK MANAGEMENT WITHOUT THE RISK VISUAL Liquid Web Commonwealth of Virginia Named User User Manual Document Version 3 Software Version 2 2 0 Published October 2009 Contents K O AV L AN cunda diia 2 VISUAL Liquid Web COV Named User User Manual cccsccsccccccccccccssssssssssssssssssccccccsscccccssccssscsssssees 3 Disclaimer Or W Ai AUN Ye eritay tent ken aji UU A 3 J AMUN AN K tt e ci kte A A e L e et e e A a ete n a 3 SO JANN L NT ds 3 System Requiem kt a anj tk at ai zi a po di 4 A DOUC ak lite a al a ip kk l ak pk a a ka e Ok lk L a a Ok a lao kal j a la l kr kl KA k k ok aba ASOU 5 FOXE CG VE AN ONE A ets ba os aka rent E A kn n at ran a denen a kf da kn ye on l d kr a a d t kk p nn an 5 e A e MO E AP APWE MO W E eatalanned meen ENB EE MOU MY RANN PA W ME A BOY SYON 5 GENTAN SO A E E A E A T 6 ACOE S UAC LIGA VWE DO picas 7 Closing the VISUAL Liquid Web Application und A aa 9 ACTO PC Ak SU DO L aie n ner eer on so ern fa a Tey rk TT a l os mtr pan ar a aa ba ert 9 Navigatine VISUA Rc LT 1quid W OD s si bess s s bi sa st oas sato kiss ss vasbas s biosos t viens s sano s pass aa on annia 10 A o e le ll ka aise a Ue ua 11 me o lala eee 11 TGs eten biyen jene e e E UA 11 VN eee onore
3. VISUAL Liquid Web contains four menus File Edit View and Help Each menu s options are explained below File The File menu contains the following options Edit View Help E Home ka Exit COW EAR E New Document Enables you to open a new COV EAR m Preferences Enables you to view and adjust reviewer alert preferences HM Exit Closes the VISUAL Liquid Web application Edit The Edit menu contains the following options These options are only available when an EAR is open Edt View Help Cut Ctrl LO py Cero Paste Ctri w Find Ctri F M Cut Deletes the highlighted text and saves a copy of it on the clipboard E Copy Copies the highlighted text to the clipboard m Paste Pastes the text previously cut or copied to the clipboard E Find Searches the open EAR for the text you specify View The View menu contains the following options A Draft yo For Review view Open Documents E Document Folders Enables you to view the following folder s contents HM Draft Displays a summary of the EARs that you have saved to the Draft folder H For Review Displays a summary of the EARs that are pending review E View Open Documents Displays a listing of the EARs that you currently have open Avizent 2009 e800 777 4283 e www AvizentRisk com Page 11 Toolbar The toolbar contains buttons which are shortcuts to various commands The table below lists the standard t
4. 5 or 9 digit postal zip code for the location where TI Posial zip code where syon occured the injury occurred If unknown enter the location where the employee works Note Use the 5 or 9 digits No Hyphens or dashes MI Avizent 2009 e800 777 4283 e www AvizentRisk com Page 31 Example Injury occurred in Zip Code 24201 Bristol VA Enter 24201 Injury Occurred at 2300 Plank Road in Fredericksburg 22401 4902 Enter 22401 or 224014902 Y Tip The US Postal Service provides an easy to use Zip Code lookup page http zip4 usps com zip4 Below is an example of this lookup service in use 1 ZIP Code Lookup mA Search By Address 5 Search By City gt gt Search By Company gt gt Find a ZIP Code by entering an address rou can also search for a partial address such as Main Street Fairfax Required Fields Address 1 2300 Flank Rd Address 2 Apt floor suite etc City IFREDERICESBURG State VA Find state abbreviation ZIP Code You Gawe Us 2300 PLANE RD FREDERICKSBURG YA Find a ZIP 4E Code By Address Results Submit gt Lookup Another ZIF Code Full Address in Standard Format g 2300 PLANK RD FREDERICKSBURG YA 22401 4902 onon Avizent 2009 e800 777 4283 e www AvizentRisk com Page 32 Automatic emails to Named Users Upon choosing an Agency with the Agency Selection tool the Agency Contacts Named Users are shown in the Contacts li
5. Employee Accident Report in the Applications box Applicatians E Es Employee Accident Report Disconnect Log Off Result The Citrix logon seript will run followed by the appearance of the VISUAL Liquid Web log in screen Starting Employee Accident Report Running logon scripts s_A 4 Click Login on the Login Screen AVIZENT User ID FGCINC waear VLW 7 Password lw Use Windows Authentication Visual Liquid web 22 SSS Avizent 2009 e800 777 4283 e www AvizentRisk com Page 8 Result VISUAL Liquid Web appears E Visual Liquid Web 2 2 File Edit New Document Home History a Visual Liquid Web 2 2 amp EFROI Com AVIZENT October 21 2009 Product Information Fisd web entry technology that fows with your business Wekome FGCINCYso Designing Forms visual Liquid Web 2 2 technology qves cients the ablity to have i customizable front end data capture products Since the product design Setting Up Alerts is built around how you capture information it is the easiest and fastest way to gather data The system integrates crectly with the VISUAL Claims Studio so you never need to re key information When you use the optional Studio Rules Engne you can auto assign adjustors attach work tasks create diaries and even set a reserve 1 2 Drat ForReview As an early innovator in the desgn of website submission of electronic event and first repo
6. Print bi Details x Delete You can access an EAR in one of two ways 1 From the View menu select Document Folders and then select For Review OR 2 Click the For Review folder icon in the left pane Result The Documents for you to review table displays in the Content pane Avizent 2009 e800 777 4283 e www AvizentRisk com Page 15 The Documents for you to review table contains the following information HM Creation Date The date the EAR was created HM Subject The name given to the EAR when it was saved E Document Version Id The unique system generated identification number m Document Name The state EAR form that was used for data entry Always COV EAR Open the EAR 1 Select the EAR that you wish to open from the list 2 Click the Edit button at the bottom of the Content pane to open the EAR OR 3 Double Click the EAR row you have selected in the list You can now review the data entered and complete additional information as needed Yisual Liquid Web 2 2 File Edit Yiew Help New Document view Open Home History L Print LA Save EJ Submit COY EAR TEST Claimant Injury John Doe Reviewing COV EAR TEST Claimant Injury John Doe Reviewing AVIZENT October 21 2009 Welcome FGCINC nso Employer s Accident Report formerly Employer s First Report of Accident The boxes Virginia Workers Compensation Commission phat mta Reason for fil
7. PrintMe Internet Printing Shift Ctrl 9 windows or use the Eny jons on the ri Adobe menu Ext com 2 C tmp3 tmp pdf Layers YE Signatures Pages Avizent 2009 e800 777 4283 e www AvizentRisk com Page 24 Deleting an EAR Caution The application will prompt you to confirm deletion However once you have clicked Yes to confirm the deletion the EAR is not retrievable You cannot delete EARS that have been completely submitted and have a claim These are contained within the History list and are permanent To delete the EAR follow the steps below 1 Click the For Review folder icon in the left pane Result The Documents for you to review table displays in the Content pane Documents for you to review AVIZENT H Subject Form Created b 113364 TEST Claimant Injury John Doe COY EAR 10 5 2009 2 56 PM October 21 2009 13361 10 5 2009 2 51 23 PM COY EAR 10 5 2009 2 51 PM Welcome FGCINC nso 1 2 Draft For Review Walidation Results Fields Results 4 Print A Detail 2 Select the EAR to be deleted 3 Click the Delete button Result A Confirm Deletion dialog box e rn Deletione displays P Are you sure vou wish to delete this document 4 Click Yes to confirm the deletion Result The EAR is deleted m Avizent 2009 e800 777 4283 e www AvizentRisk com Page 25 Entering a New EAR COV EARs can be entered by Generic Users or Named
8. dekole te be tasyon se ce sateen ogee dene cosa koni oo eta noise k eee kek e e e lasyon ke n 11 cd OOM AE kw f e o re a it reny A te eye e e te ayen ea k 12 Standar BOOS tada 12 COMA cra Rda 13 Pi A O A AA ket e Re ee t 13 Example Document Cycle Work Wisin aii id 14 Usme VISUAL Elquid W Wiii ss tid ase ok oke oua kote osle io kipa said w die kw du fib ol pl kal alkol a le a l kt ias 15 Viewing Updating the EARS you have to Review hLLLeeeeeeeetttttttttttoootooooeeee0000099421teooooooeooooooeeesesssseeeeeeooooooooooannnaanoonon 15 Open TN RAR apo ti o 16 Named User Reviewer Owners IP io dyol pipi aa 17 Data Enter sects napa 17 Reguired Piels a ke via abi ss pab loa wk ik pele 19 od ope a tb ks o E kk it e E al a e kon a a bek it 20 Closmo an EAR a fa n tb kn k n kt ks S n ka to a a eko kb e pi 21 Printer Troubleshooting eya koi ta oti bab a 24 Closing Adobe Reader WINAOW L 000002eeettettteteee eee aa aaa aaaaeeeettttatotorootoooooooeeeeeeeeeeettoooooooooooooooeesesssssseeoeooooooooooooooooooon 24 DGIC HGS an EAR 0 A A A BA kn a ak ob k ai lt 25 Ent rins a New EAR sous iyis alias taba son a daf kalib kat ta l ta A po ka a ki oi aa t 26 DATE a NEW PPP a e O te ka n eya n im dodin kak nn ba tea 26 E o ao a Pen E ky aou A a OO HOS Pye Aks kad ee kaka kanse 30 Agency Control and assignment wi g sauis des swa da sila ks st bo ko k Green bi s k ai bib a k ew eee kaka AE A Ok sa L a kasik 31 Automatic e
9. location tree to collapse or expand the location tree Use the Find box to search for location numbers or names In the Email Addresses field top left enter additional email addresses in addition to those of the HR personnel displayed in 4 above separated by commas but no spaces Initial submission email and a 2 submission notice with form attached will be sent to the address s It is possible to use your Tab button to move through the form Note Tabbing to a Yes No type button field will automatically select the first choice You may then change your choice or if you want to keep it empty press the ENTER button on your keyboard to unselect In the Validation Results area on the left side double clicking an item will take you to the item on the form The following items must be completed if possible by the Named or Generic User 11 Postal zip code where injury occurred 12 Date of Injury Tip Click the drop down arrow to select the date with the calendar 13 Hour of Injury 14 Date of Incapacity 1st day missed work 16 Was employee paid in full for day of injury 18 Date Injury or Illness Reported Avizent 2009 e800 777 4283 e www AvizentRisk com Page 26 22 Employee First Name Employee Last Name 23 Phone Number of Injured Worker 24 Sex 25 Address of Injured Worker 26 Date of Birth 27 Marital Status 28 Social Security Number 29 Occupation at time of Injury 42 Describe
10. name amann Password Please Click the button labeled Log In to begin the process Welcome to The Conmmoanwo ealth of regina Employee Accident Form Suber Portal This ts Gitte 4 8 presentation server Dar hosted at Avizent s Notional Dala Center located in Dubli Cha Kai ane ee Than Click the con labled Employee Accident Report to begin entering your claim Then Click the YLA Icon labled Login to activate Visual Liquid Web Select Mew Document then oF ROT thon COM FAR and begr billing out tho harri Once the forme complete Pant then Subout the born ta complete thr process For support please Contact our Help Desk Gur dedicated IT professionals are waiting to help you resolve your problem Whit our core Help Desk hour ans Monday through Freday 8 00 AM to 00 PM EST we offer around the clock hechrcal support for report prrporstss Pest contact us by em ding halpdceskiasvizantrisk Comi telephone B00 727 4233 or submitting your request onlin Message Center The Message Centier displays any intarmati n ar errar m s aos that may occur Result The Visual Liquid Web Intake home page displays 2 Enter the User name and Password supplied to you then click the Log In button in the box on the upper left of the screen User name JDoe Password Advanced Options gt gt gt Result The Applications box displays Avizent O 2009 e800 777 4283 e www AvizentRisk com Page 7 3 Click
11. the system validates the data entered M If all the required information is complete and valid the claim is submitted to claims processing A window displays containing the claim number assigned to the new claim such as the one shown below Click OK to close the window Claim submitted successfully A Your claim number is 20050040010243 33 m If all the required information is not complete or if the EAR contains invalid information the system will prompt you to correct the validation errors before submitting Avizent O 2009 e800 777 4283 e www AvizentRisk com Page 20 After all the required information is successfully validated the EAR is sent to MCI claims processing Note lf the claim is a duplicate claim the system will recognize this and not allow you to Submit it The system will display a message such as the following Claim submitted successfully A claim currently exists for the entered SSN and date of injury A duplicate claim cannot be created Existing Claim Number 20050040010245 If this occurs contact the Technical Support service listed below for further instructions Caution Once you successfully submit an EAR you cannot make any changes to it in VISUAL Liquid Web See Viewing EAR History for more information Closing an EAR If you need to close an open EAR click on the X in the upper right corner of the EFROI toolbar The EAR will close El Subri COV EAR KEW Employer s Accident Report
12. Avizent in the United States and or other countries All rights reserved All other product names and services used throughout this manual are trademarks of their respective companies Copyrights Complying with all applicable copyright laws is the responsibility of the user Without limiting the rights under copyright no part of this document may be reproduced stored in or introduced into a retrieval system or transmitted in any form or by any means electronic mechanical photocopying recording or otherwise or for any purpose without the express written permission of Avizent Avizent may have patents patent applications trademarks copyrights or other intellectual property rights covering subject matter in this document Except as expressly provided in any written license agreement from Avizent the furnishing of this document does not give you any license to these patents trademarks copyrights or other intellectual property 2009 Avizent All rights reserved Any example companies or persons depicted herein are fictitious No association with any real company or persons is intended or should be inferred Avizent 2009 e800 777 4283 e www AvizentRisk com Page 3 System Requirements The following table outlines the system requirements for optimal performance Item Minimum Recommended Software Citrix ICA client for Citrix ICA client for Windows Windows Internet Browser IE 6 SP2 SSL 2 and 3 IE 6 SP2 SSL 2 and 3 enab
13. COV EAR June 17 2008 Welcome FGCINC vaear hr2 Privacy Statement Legal Notice EZ Avizent O 2009 e800 777 4283 e www AvizentRisk com Page 22 To print the EAR follow the steps below 1 Click the Print button Result A PDF version of the EAR is generated Adobe Acrobat launches and displays the PDF on your screen 6 Adobe Acrobat Standard imp1C0 tmp pdf AE File Edit view Document Comments Tools Advanced window Help i Bookmarks T SN Li Model T z Je Comments Avizent 2009 e800 777 4283 e www AvizentRisk com Page 23 2 Click the Print Form button on the Acrobat toolbar Printer Name SHELLS SRT Yonn vi Status Ready Comments and Forms Specify the desired settings and click OK Print Flange aa Result The EAR is printed to the specified DAN printer Current view Type HP LaserJet Document and Stamps C urr ent p ag e O Pages i E Subset ge Reverse pages Page Handling Copies Collate 0 tas bebi a sett po eman eS ea a Res SSS ATITID 1 ue Page Scaling Reduce to Printer Margins v Auto Rotate and Center re a t C Choose Paper Source by PDF page size Print to file Units Inches Zoom 92 1 1 1 Printer Troubleshooting Note Printing within the remotely hosted Adobe Reader application may sometimes fail If this occurs you have a couple of opt
14. COVEAR 2 6 2009 11 00 AM 5697 Schrute Dwight 1 209 COV EAR 2 6 2009 10 49 AM 200230040000126 5695 Bernard Andrew 2H 4109 COV EAR 2 6 2009 10 34 AM 20090040000117 Details Avizent 2009 e800 777 4283 e www AvizentRisk com Page 34 Index About 5 Accessing Technical Support 9 Accessing VISUAL Liquid Web 7 Agency Control and Assignment 31 Closing an EAR 21 Closing the VISUAL Liquid Web Application 9 Content Pane 14 Copyrights 3 Data Entry Features 18 Deleting an EAR Draft 25 Disclaimer of Warranty 3 Edit 11 Emails to Named Users 32 Entering a New EAR 26 Example Document Cycle Workflow 15 File 11 Getting Started 6 Graphic Alerts 5 Index 34 Avizent 2009 e800 777 4283 e www AvizentRisk com Left Pane 14 Menus 11 Navigating VISUAL Liquid Web 10 Ownership by Named user 18 Printing an EAR 22 Refreshing your Folder Contents 33 Sample Blank Form 28 Standard Buttons 13 Submitting an EAR 20 System Requirements 4 Text Conventions 5 Toolbar 13 Trademarks 3 Using VISUAL Liquid Web 16 View 11 Viewing EAR History 33 Viewing Updating the EARs you have to Review 16 Page 35
15. Fed Fax fa Number 3 Employer Case No If applicable 5 Location if different from mailing address fl 6 Parent corporation Policy Named Insured If applicable or PEO name Nature of business Commonwealth of Virginia 8 Name of Insurer or sell ingurer for this claim Address of Insurer or self insurer for this claim Managed Care Innovations L L C PO Bos 1140 Richmond YA 23218 City State Ap 3 Policy number Self Insured 15 Hour of incapacity 21 f fatal give date of death TN 31 Number of dependents ar Value of perquisites per week PO Eo 36 Wages per hour 39 Earnings per week inc OT Food meal Lodging DOD OU OU 000 40 Machine tool or object causing injury or illness 41 Specify part of machine etc 50 EMPLOYER prepared by name signature title 51 Date 52 Phone number bl 55 Phone number 36 THIRD PARTY ADMINISTRATOR If applicable of Address 38 Phone number Managed Care Innovations L L C PO Box 1140 J City Richmond Were Safely Regulations Valed Wasa Droog Alcohol 5 creenng Pe omed Wasa Jo Pany Aesponzible for inay Es Yes No Party Mame Party Address Party Phone aaa lf Ves Comments to Carrer Claim Staff Avizent 2009 e800 777 4283 e www AvizentRisk com Page 30 Agency Control and assignment The Agency control must be completed prior to the intial submission Any user completing
16. Users If a Named User enters a new COV EAR then the EAR will display in his her For Review folder The Named User will then have to open the AR and submit it again to complete the transmission to VCS Entering a New EAR EARs can be entered by Generic Users or Named Users If a Named User enters a new EAR the EAR will display in the For Review folder The Named User must re open the EAR and submit it again to complete the transmission to MCI You may also see EARs For Review submitted by Generic Users See For Review EARs below 4 5 10 11 12 Click the New Document toolbar button select eFROI and then select COV EAR Click Siew Selection in the Agency Control in the Employer area Scroll down the list and pick your Agency If applicable also pick your Sub Agency You must click 27 27 and verify the identity and email address of the HR personnel who will complete the second submission An initial submission email and a second final submission notice with form attached will be sent to the address s In the Name of Employer field search for the employer by name From the Select Org drop down list select Find by Name Double click 4024 Commonwealth of Virginia Select the injured worker s place of employment from the list Tips You know that an employer is available for selection when there is a green check mark Click Display Number to see the Agency Code s Right Click on the employer
17. ach of these named users will be able to see the forms submitted for this location If an eligible reviewer opens and updates saves the form this user then is the sole assigned reviewer and other users will not be able to see and edit the form This allows the reviewers to open a report to view without taking exclusive ownership unless they update it Data Entry Features The following features are available to ease your data entry E Required Fields tThe required fields have a pink border They are also listed in the Validation Results area The Validation Results area acts as a checklist for required information As the required fields are completed they are removed from the Validation Results area E Pre Formatted Numeric Fields Information that is normally displayed with formatting such as dashes in phone numbers or social security numbers can be entered with or without the dashes E Drop down Selections Enter the first character to move directly to that point in the selection list Up and down arrows can be used to navigate further HM Radio buttons Allow toggle selection of one of several choices Yes No Male Female etc 1 Free Form Text 19 Person to whom reported You can type freely within these fields David Wallace You can copy and Paste in these fields 72 Date of irviay October 2 Dates AT AN di i m gi Jwe Wea E i With drop down calendars ON m 2 lt a Hl 5 6 7 8 2 W TI You c
18. an initial submission for review must complete this field before it will be accepted Requiring this selection before any submission provides assurance the report will be assigned to a valid HR reviewer for final submission Show Display Agencies Agency 5876 Dunder Mifflin sere Dunder Mifflin vi 55555 Scranton Branch Sub Agencies 55555 Scranton Branch Contacts First Mame Last Name E mail Show display MUST BE clicked to submit your E ovmichaelsc micheal scott dundermifflin com report It will reveal the contacts this report will be fe Jovtobyflender toby flenderson dundemifflin com referred to for review The selectionwill turn Bray E ovpambeesle pam beesley dundermifflin com but may be re selected by clicking Show Selection Document is invalid for submission a e p A This warning will pop up if you do not ZAN Could not submit Agency Control has not been filled in i select an Agency and click SHOW DISPLAY Please go back to the Agency control make a selection and click Show Display to proceed Error Message Could not submit Agency control has not been filled in This error will prevent you from submitting Ensure you have selected Show Display and can see the Contacts You may have to reselect the Agency again if you continue to have trouble The button label switches between Show Selection and Show Display as you use it Postal Zip Code Field Requires the
19. an use the arrows to navigate by You can type over the date i a a E 4 Month and by Year fields for MM DD YYYY ES Type over to replace elements such as year after picking via calendar Type over to replace elements such as yer after picking via calendar 3 Time with up and down arrows 13 Hour of injury Avizent 2009 e800 777 4283 e www AvizentRisk com Page 17 4 Yes No radio buttons 16 Was empfopee pand infill f Note When in a field which contains radio buttons to select neither button press Enter instead of tab to exit the field To Unselect all choices 1 Avizent 2009 e800 777 4283 e www AvizentRisk com Page 18 Required Fields File Edit New Document lt 4 Submit COW EAR NEW AVIZENT June 13 2008 Employer s Accident Report PA d Vaidation Resuts formerly Employer s First Report of Accident The boxes Virginia Workers Compensation Commission to ma de al Reason for filing Insurer location fields Fiesults 1000 DMY Drive Richmond VA 23220 ven olihe mean E m Eil i See instructions on the reverse ofthis form Suter Employee Last Name Required l a Employer FEIN data required a a a ee m ia a The pink border around a field indicates that the field is Date Of Injury data required required data required CSET IA gt n Employer Name data required data required 1 Name of Employer trading as pues caliza alli bal ltd a Show Selection Agency SubAgenc
20. dress M Displar Number Locations Select Org Show Displar Firat Wet Previous Case Sense A ffimeandPlaceofAesilen O O O O O O S 11 Postal zp code here mun occured 12 Dafe of ryu TA our oF iyi 13a Time began work 14 Date of incapacity f Wart emplopee paid infullfor dap ofinjuny 17 Wat employee pad infiuil for dap mcapacip began Ic Yer Na lc Yez Ho TE Dale syon or ness reposed 19 Person to whom reported 20 Name of other witness ka Avizent O 2009 e800 777 4283 e www AvizentRisk com Page 28 TSX 22 Mame af anploye ji asi Middle 23 Phone number Employee Work Number o ft Employee Cell Phone 2d Ser ji e Male Female 26 Dale of bn 22 Mantalstalus Single O Dicer O Mamed 26 Social secu number 29 Occupation at time of injury or illness EEE 34 War emplopee paid ona piece work of hourly bass Ic Piece Work Hourly 42 Deranbe fal fos aay of tere occured Cause afime Code dad Deronbe nafure of sun o ness Paris of body afeched ke ee dane a a Ji mennene vi Ic es No e es No 44 Physician name 45 Hospital or Clinic name Physician address Hospital or Clinic address 47 Aas employee returned fo mok Es es C Na 46 Probable length of disability Avizent 2009 e800 777 4283 e www AvizentRisk com Page 29 COMPLETE THIS SECTION IN ACCORDANCE WITH YOUR HUMAN RESOURCE DEPARTMENT S INSTRUCTIONS n 7 2
21. fully how injury occurred Select Cause Code 43 Describe Nature of Injury or Illness Select Part of body affected 31 Number of Dependent Children 47 Has employee returned to work 48 If yes On what date Note As a Named User you should also ensure the following is completed prior to submission to VCS Type of Claim Indemnity You expect lost time greater than 7 days Medical Only Not Indemnity but Hospital or Physician treatment is expected Record Only Incident Only first aid only 2 Fed Tax ld No Your Agency s FEIN 33 Date of Hire 36NCCI Occupational Classification Avizent 2009 e800 777 4283 e www AvizentRisk com Page 2 Sample Blank Form COV EAR New Employer s Accident Report formerly Employers First Report of Accident The boxes Virginia Workers Compensation Commission a nen Reason for filing Insurer location 1000 OMY Drive Richmond v 23220 use of the enn 752 Insurer See inrirucHornz on ihe reverse of fr fons Insurer claim number Enter email addresses tosend submission notice and recere copy of EAR andClaim Number upon final submission For multiples separate addresses with comma No Spaces ee THIS SECTION TO BE COMPLETED BY EMPLOYEE SUPERVISOR Ken w n Click button to edit gt Stew Salecion Agena Subd gene Contacts man man mean Ee Ey pO ES EL 1 Hame of Employer trading as or doing business as if applicable and 4 Mailing Ad
22. ing Insurer location 1000 DMY Drive Richmond VA 23220 use of the 762 i insurer Seesnstructions on the reverse of this form Insurer claim number Enter email addresses to send submission notice and recerve CTT For multiples separate addresses with comma No Spaces anonymoususer vavlw com THIS SECTION TO BE COMPLETED BY EMPLOYEE SUPERVISOR 1 2 Draft For Review Walidation Results Fields esa I empty Claim Type Required Click button to edit gt Show Selection Employee First Name Required Employee Last Name Required Agency 363 VIRGINIA LIASON OFFICE Sts Employer FEIN data required Date Of Injury data required sub Agency Employer Name data required Contacts Social Security data required First Name Last Name Email Type of Claim data required fn T Bo o e Time Of Injury data required Es 3 MEA Nature Of Injury data required ee O n Part Of Body Injured data required Tip You can move from field to field on the form by pressing the TAB key Note Tabbing to a Yes No type button field will automatically select the first choice You may then change your choice or if you want to keep it empty press the ENTER button on your keyboard to unselect Avizent 2009 e800 777 4283 e www AvizentRisk com Page 16 Named User Reviewer Ownership If an employer has multiple Named users for the Agency subagency combination chosen during form creation e
23. ions 1 With the current document safely saved within the Draft or Review queue close the application to log off of the system Log back in re open the document and reattempt the print request 2 Make sure your email address is one of the addresses within the Contacts list or add your address to the Email address box in the upper left hand corner of the form Once the second submission is complete and a claim has been created a copy of the form will be emailed back to your account Closing Adobe Reader window Be careful when closing the Adobe Reader window so that you do not close the entire VLW application in the process If you see multiple check boxes IK be careful to only click on the inner most box or use the Adobe Reader Menu to select File Exit to close Do not Close outermost window Employee Accident Report HR Citrix XenApp Plugins for Hosted Apps FT Adobe Reader tmp3 tmp pdf File Edit View Document Tools Window Help Create Adobe PDE Online Share photos like a y Ctri O pro bpy For your records gt Print Form T Highlight Fields Diaital Editions gt Close Ctrl Save a Copy Shift Ctrl S IS Save as Text A a a Jan 01 0001 12 00AM bou pyer s ACCK AL Document Properties Ctrl D ka l k VWC file number mployer s First Print Setup Shift Ctrl P orkers Co mpen me Print Ctrl P le Only close the Adobe
24. led enabled Screen Resolution 1024 x 768 1024 x 768 See the companion guide VISUAL Liquid Web Citrix client Installation for details on installing Citrix Citrix allows you to use complex hosted applciations over the internet with only your computer and an internet connection Avizent 2009 e800 777 4283 e www AvizentRisk com Page 4 About This document is intended as a guide for users of the Avizent VISUAL Liquid Web product This document provides a description of the VISUAL Liquid Web application including instructions for accessing and using the application and how to reach technical support Text Conventions The following text conventions are used in this document Element bold text Characters that you type exactly as shown menus and menu commands command buttons command prompts list or drop down boxes titles and selections tab and dialog box titles and options Italic Font Variables for which you supply a specific value information that you supply ALL CAPITALS Acronyms names of certain commands keys on the keyboard Initial Capitals Names of applications screens programs field names Graphic Alerts The following graphic alerts are used in this document Element Description Caution Alerts you to potential problems such as data loss or security breaches Example Provides a hands on interactive lesson or indicates material that helps clarify the current discussion Note Alerts you to
25. mails to Nam d USCIS ewe snacanczdemcaceccemenepiactnetines dnacnqetdemensedonmenqeantnntinesdundened demennedduinsnaeantmerneadnecameddencncecdumsnaett 33 Refreshing your Folder Contents cccccccccccccccceceeeessesesseeeeeeeeeeeeeeeeeeaeeeeeesseeeeeeeeeeeeeeeeeeeeeeaaaeeeeeeeeeeeeeeeeeeeaaaaaaaeesses 34 AA 50 O O 35 Avizent O 2009 e800 777 4283 e www AvizentRisk com Page 2 VISUAL Liquid Web COV Named User User ManualDisclaimer of Warranty Avizent and its affiliates are committed to providing the best quality product possible but specifically disclaim warranty of any kind and shall not be liable for loss of profit or any other damages The Avizent software its modules and the contents of this manual are provided as is and are subject to change without prior notice The information contained in this document represents the current views of Avizent on the issues discussed as of the date of publication This manual describes available modules and sub applications for Avizent products including items which may not be included in the base delivery model which may be optional or which may be separately priced Because Avizent must respond to changing market conditions it should not be interpreted to be a commitment on the part of Avizent and Avizent cannot guarantee the accuracy of any information presented after the date of publication Trademarks The VISUAL Liquid Web software product and the VISUAL Liquid Web logo are trademarks of
26. ober 21 2009 Welcome FGCIMCAnso Designing Forms Product Information Setting Up Alerts Review and Draft Queues 1 2 Draf For Rewiew Validation Results Fields Results Avizent 2009 e800 777 4283 e www AvizentRisk com Tool Buttons and Menus Visual Liquid Web 2 2 8 EFROI Com Alu web entry technology that Hows with your business Visual Liquid Web 2 2 technology gives clients the ability to have customizable front end data capture products Since the product design is built around how you capture information it is the easiest and fastest way to gather data The system integrates directly with the VISUAL Claims Studio so you never need to re key information When you use the optional Studio Rules Engine you can auto assign adjustors attach work tasks create diaries and even set a reserve As an early innovator in the design of website submission of electronic event and first reporting we formed EFROLCom This online hosted service allows clients to electronically capture Event and State First Reports of Injury data over the web The system produces the required supporting forms and routes them directly to your data warehouse third party administrator insurance company or corporate office Completed data can be stored on our data warehouse on your mainframe or on your PC the choice is yours EFROI com is the simple fast and cost effective way to file events Content Pane Page 10 Menus
27. on an item in the Validation Results field s list to jump to its entry field in the EAR Avizent 2009 e800 777 4283 e www AvizentRisk com Page 13 Example Document Cycle Workflow Email also sent to email addresses entered by the anonymous user in the Email address field on the EAR Anonymous user enters claim Email notification is sent to the into VISUAL Liquid Web using Agency HR contact s COV EAR Named Users The submitted report will display in the named user s For Review folder Anonymous user can print form submitted Named user reviews and completes EAR performs initial investigation and submits claim Email sent to Named User s with new Avizent claim number and copy of the Accident EAR report Claim received by MCI staff and assigned to the appropriate claims team member Avizent 2009 e800 777 4283 e www AvizentRisk com Page 14 Using VISUAL Liquid Web Viewing Updating the EARs you have to Review You will be notified that you have an EAR to review in several ways M You may also notice that you have EARs to review when the number of documents in your For Review folder increases E Visual Liquid Web 2 2 E la x File Edit view Help New Document AVIZENT Subject Created TEST Claimant Injury John Doe COW Es October 21 2009 10 5 2009 2 51 23 PM 10 5 2009 2 51 PM welcome FGCINCinso 1 Draft For Review Walidation Results Fields Results au b
28. ontent Pane The Content Pane will display the Employer s Accident Report Left Pane The left pane contains the following areas HM User Information Displays the current day s date and your application user name AVIZENT HM Folders Contains the Draft and For Review folders June 17 2008 and displays the number of EARs in each folder Welcome FGCINC vaear hrl HM Draft Contains those EARs that are in process These are EARs which have been created by the Named User and saved without being Submitted H For Review Contains EARS that have passed initial validation requirements but may need some further information or oversight before final submission Anonymous users will submit drafts to 0 0 Named Users for review Named Users will then Drat For Review review the draft and submit it for claims processing If a Named User enters a new EAR and submits it it will display in his her For Review folder Validation Results which are required for the COV EAR This list is Employee First Name updated as you enter information so that you can see at a glance which required fields still need to be completed W Validation Results Contains a listing of the data fields Employee Last Name Required Employer FEIM data required Date OF Injury data required Employer Hame data required Agency data required Social Security data required Type of Claim data required Tip You can also double click
29. oolbar buttons in VISUAL Liquid Web Button Description Ge New Document Enables you to enter a new EAR into the system MA View Open Displays the tabs for all the open EARs The most recently viewed EAR is displayed on screen E l i Home Takes you back to the initial startup screen ome Jo El i History Enables you to review prior claim submissions completed with your account History Standard Buttons In addition to the toolbar buttons other buttons are available throughout the application Not all buttons are available on all screens The following table contains a listing of all of the buttons available in the application Button Description Delete Deletes the EAR file Details Displays EAR details such as submission date subject claim number and submitted by Edit Enables you to update the information displayed on the EAR CAMEO oi Print ai Print Generates an electronic copy PDF of the EAR which can be printed E Refresh A E Refresh Refresh Retrieves the latest information from the database and forces a refresh of the data being viewed Save Saves the information entered on the EAR You will be prompted to enter a Subject Name for the document Submit Submits the completed EAR to the system designated reviewer Support Sends a support inquiry email to product support View Displays requested item Avizent 2009 e800 777 4283 e www AvizentRisk com Page 12 C
30. rting we formed EFRDI Com This onine hosted service allows cients to electronically capture Event and State First ae Reports of Injury data over the web The system produces the required Validation Results MA l a supportna forms and routes them directly to your data warenoLse third Fields Results party admiristrator insurance company or corpcrate office Completed data can be stored on our data warenouse on your mainframe or on your PC tha chcice is yours EFROI com is the simple fast and cast effectye way to file events If you have problems logging in contact tccO avizentrisk com or 800 727 4283 for assistance Closing the VISUAL Liquid Web Application To exit the application on the File menu select Exit The application will close If you have open EARs with unsaved changes the system will prompt you to save the changes before closing Accessing Technical Support Technical support for this Avizent product is available through the Help Desk tccO avizentrisk com or 800 727 4283 Avizent 2009 e800 777 4283 e www AvizentRisk com Page 9 Navigating VISUAL Liquid Web Once you are logged in VISUAL Liquid Web s home screen displays The primary navigation for VISUAL Liquid Web is found in the toolbar and in the left pane The larger Content pane is on the right You can also navigate using the menus FE Visual Liquid Web 2 2 File Edit View Help o OE New Document Home History AVIZENT Oct
31. st below the selection Upon submission of the form notification emails will be sent automatically to these addresses Show Display Agencies 9876 Dunder Mifflin El NS You must click on Show Display ee before submitting your report 55555 Scranton Branch vi You can then review your HR reviewer contacts that will review the form for final submission Show Selection Agency 5876 Dunder Mifflin Sub 6gencu 55555 Scranton Branch i das a Emails will be sent to these Contacts addresses upon submission First Hame Last Name E mail fe ovmichaelsc micheal scott dundemmitflin com E ovtobyflender toby flenderson dundermifflin com E ovpambeesle pam beesley dundermitflin com The email field is still available Enter email addresses tosend submission notice and receive on the form copy of EAR andClaim Number upon final submission For multiples separate addresses with comma No Spaces Addresses may still be added ihalpert dundertmifflin com amartin dundermifflin com to send notices to additional addresses that do not appear Zo Manually entered addresses may still be used in the Contacts list They will be added to the email list with the contacts In this example these two addresses and the three contacts will be emailed Avizent 2009 e800 777 4283 e www AvizentRisk com Page 33 Refreshing your Folder Contents To ensure that you have the most recent information in your For Revie
32. supplementary information Y Tip Provides additional information that may be helpful to task completion such as shortcuts Avizent O 2009 e800 777 4283 e www AvizentRisk com Page 5 Getting Started VISUAL Liquid Web 1s an electronic forms processing and data capture system VISUAL Liquid Web ensures that all the information necessary to submit a COV Employer s Accident Report EAR is captured on its easy to use screens This feature ensures that all EARs submitted have the minimum state required information completed VISUAL Liquid Web 2 2 integrates directly with the VISUAL Claims Studio software suite so there is never a need to re key information Field and document level validation ensures that documents adhere to the configured document specific rules As an early innovator in the design of web site submission of electronic event and first reporting we formed EFROI COM M This online hosted service allows clients to electronically capture Event and State First Reports of Injury data over the web EFROI COM is the simple fast and cost effective way to file events VISUAL Liquid Web users will also enjoy the ability to generate and print forms Avizent 2009 e800 777 4283 e www AvizentRisk com Page 6 Accessing VISUAL Liquid Web 1 In your Internet browser s address field type https apps frankgates com vaear hr and press Enter MY APPLICATIONS AVIZENT Web Interface Frank Gates ferwice Ca kitenta User
33. w folder or the Draft folder you can click the blue label text The system will update your display 1 2 Liratft For Keyi vw Viewing EAR History Click on the History button to view prior complete submissions You may review your past EAR submissions after final submission Only EARs submitted by your personal account can be viewed You cannot change or edit these Historical documents but they can be viewed to verify the data you submitted HR users now have a History Button 1 tw hae kr z AR users may review reports File Edit View lp MAN they previously submitted Only He ocumenis they have submitteo are visiable Documests histoncal Te Subiect Fom Created New Document AA e JI 5718 En COW EAR 210 a PM 5718 ohn doe COW EAR 2 10 2008 1 18 Pik February 18 2009 kou Paes l a E Welcome FGONC vaeanga hr poy es 271072009 1 10 PM o VA EAR _ COVEAR 2 6 2009 5 36 PM 20090040000123 moO N ETA lso rE 21642009 4 45 PM s L j 4 EE l Fo di l 18920040000004 History documents may be AR Er t opened for review but no further changes or submissions can be made zmona 200900400001 20 f 20020040000119 eann oven aana asco Wayne John 5115 2008 Wayne John 54152005 COV EAR 2 6 2009 11 02 AM 5699 f Test ARAB
34. y The Validation Contacts Results area acts as a checklist for required fields I Display Number Locations Select Org Show Display End Hen Previous Case Sensitive REQUIRED FIELDS Based on data processing needs these are subject to change Fields are listed in the Validation Results area on the left pane are system required They must be completed to be accepted by the claim administrator Other fields may also be required In all cases you should complete all of the information known to you at the time A AAA YN Page 19 Avizent 2009 e800 777 4283 e www AvizentRisk com Submitting an EAR Submitting an EAR promotes or forwards the document to claims processing To submit an EAR click the Submit button on the EFROI toolbar cor NE Employers Accident Report Ciwasarhr formerly Employers First Report of Accident Virginia Workers Compensation Commission Richmond YA 23220 An ite reverse of five fos If you have previously saved the document it is submitted to the system specified reviewer or to the system as a claim If you have not saved the document you are prompted to enter a a O og E Please enter a subject name for this document Subject Last Name First name Dlate of Injury Note lt is suggested that the subject include the claimant s last name first name and date of injury as shown above After you have clicked Submit

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