Tick Tock
This setup process takes its name from the initial period required for claim activities.
What is the 5-Day Setup?
What is Policy Financials?
To verify coverage, confirm that this injury-related date falls within the policy period.
What is the date of injury, or DOI?
These should be established by Day 5 based on the probable ultimate cost of the claim.
What are initial reserves?
These three letters identify the claim-handling roadmap that should tell the story of the claim and how it will be managed toward MMI.
What is the POA, or Plan of Action?
This event starts the clock, even if you have not yet made successful contact.
What is a claim assignment?
This resource within the claim contains the coverage template.
What are the Claims Quality Standards?
The policy screen shows what ___________ company information, which ought to be included in the coverage note.
What is the underwriting company?
After the initial reserve, this is how often reserves should be reevaluated and separately documented for continued accuracy.
What is every 90 days?
An ongoing Plan of Action generally continues on this schedule, unless Special Handling Instructions say otherwise.
What is every 30 days?
You receive a reassigned claim rather than a brand-new claim. This setup process still applies.
What is the 5 day Setup?
Under Special Handling Instructions, this selection lets you access customer documents containing the SHIs.
What is Customer Documents?
Day 1 documentation requires separate notes for which two categories.
What is Coverage and Excess Coverage?
A change in treatment, benefit duration, PPD, or the need for legal, NCM, or IME expenses may trigger this action.
What is reevaluating and changing the reserves when appropriate?
Surgery, prolonged return to work, litigation, and changes in treatment or employment status are examples of these events that may require you to revise your POA.
What are triggering events?
Day 1 coverage documentation and initial contact activities fall within this many hours of assignment.
What are the first 24 hours?
The SHIs are not linked to the customer document. This is the next location to check.
What is Major Accounts?
Your excess note says the claim is “not reportable,” but does not explain why. This required element is missing.
What is the rationale for the reportability decision?
On Day 10, this financial action is due, along with any required corresponding state documents.
What is issuing the first payment?
After seven business days, unsuccessful attempts to contact this party should be escalated to leadership and the account manager.
Who is the employer?
A coverage issue remains unresolved. Name both the Day 2 escalation action and the investigation action required within three business days.
You need to verify the policy period and carrier for an older takeover claim. Name the Excel resource and where to find it.
What is the Policy Index in Major Accounts?
An excess note already lists the carrier, policy number, policy dates, and work class code. Name the four additional items needed to address excess coverage and reporting.
Your initial reserve covers current treatment but nothing beyond it. Name at least three additional future exposures that should be considered when setting reserves.
What are any three of:
Put these four milestones in order and give the correct day for each:
First payment, initial reserves/coding, completed initial investigation, carrier report when reportable.