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
RepRelationship
Valid relationship values (choose only one)
Guardian/Admin
Other
Relative
A representative is required if the claimant is deceased or incompetent.