RepresentativeInformation

Representative Information

Representative Information is as follows. The required information for any representative information to be processed by the SimpleBatch system is in bold. If the minimum required information is not provided, no representative data will be imported into eClaims.

• RepLastName

• RepFirstName

• RepMI

• RepSuffix

• Complete Rep Address

  • see address requirements

• RepRelationship

  • Valid relationship values (choose only one)

    • Guardian/Admin

    • Other

    • Relative

A representative is required if the claimant is deceased or incompetent.