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Download How to Bill for an Occupational Disease History Report (Code 1055M (F242-432-000) – Department of Labor and Industries (Washington) form. 040, an employer shall complete and file with his or her insurer or third-party administrator an employer's report of industrial injury or occupational disease.MassHealth List of EOB Codes Appearing on the Remittance Advice. AN ACT to amend and reenact subdivision a of subsection 2 of section 28-32-01 and section 32-12. S.B. 43 Occupational and Professional Licensing Modifications. Appendix C – Medicaid Eligibility Codes on the FMMIS Recipient. Or keeping track of monthly bills. Administrative Law Judge's Report and Recommendations. Appendix A – Course Codes. Course Codes are found in the Course Codes – App A spreadsheet on the Pennsylvania Department of.