Form WC-104B Updated

October 2, 2013

Form WC-104B, Application for Mediation or Hearing - Form B, has been updated and is now available for use. The only change is the addition of boxes at the bottom of the form for the applicant’s email address and the attorney’s phone number (if applicable). The Agency asks that providers begin using the updated form immediately. If there are any questions, please call 1-888-396-5041.