Medicare
Injured Worker Experience
Financial Management
If It's Not Posted, It's Not Done.
GRS North America
100

Claims can proceed with fully commutated MSA excluding treatment costs for the denied body part/condition.

What is I have a Court Order that denies a specific body part/condition.

100

What has replaced the Injured Worker's Toolkit?

What is Injured Worker Portal?

100
When is a reserve change due once new case facts or information is received that indicates a change in exposure?

What is within 5 business days?

100

The mechanism by which some customers can view Journal Entries.

What is Risktrac?

100

Tracy Ryan

Who is President, GRS North America?

200

Beneficiaries enrolled in both Medicare and Medicaid.

What is dually eligible beneficiaries?

200

Non-medical issues that can impede the injured worker's recovery; early indicators of high-risk, prolonged disability.

What are yellow flags?

200

System generated 15 months after policy inception and are to be processed within 30 calendar days from add date and are inclusive of the add date./

What are 51/unit reserve notes?

200

Information that should not be shared with any party outside of claims.

What is confidential information such as SSN, comorbids, etc?

200

Steve Deane.

Who is Chief Claims Officer, GRS North America?

300

Basis for prescription pricing for MSA.

What is AWP (Average Wholesale Pricing?)

300

Conditions that may impact the injured worker's recovery from a compensable injury?

What are comorbid conditions?

300
Process to recover overpayment when repayment is expected to be obtained in less than 30 days?

What is document in Journal Entry and follow up for receipt of repayment?

300

Consists of several sections of information including customer, injured worker (claimant), injury, accident, Medicare/Medicaid, SSDI, disability, work status, reserves, and legal.

What is Claim Overview?

300
Focusing on the customer; putting the customer's needs at the forefront and providing top level customer service.

What is Customer Centricity?

400

Injured worker is at MMI but MSA will project future treatment based on this standard.

What is standard of medical care for the diagnosis?

400

Contact with the customer, employer and medical provider that is to be completed within 1 business day of receipt of a lost time claim.

What is initial 3 point contact or ICP?

400

A case that involves an injury that results in death, permanent total disability or lifetime permanent partial disability.

What is a life pension case?

400
Requires market approval in order to use in file posting.

What are abbreviations?

400

Resource that is required to be engaged when claims reach a total incurred of $500k or more or have other specific criteria that has been met.

What is HO Examining?.

500

Reasonable expectation of being a Medicare beneficiary within 30 months of settlement and settlement payout is > $250k

What is a Class II Beneficiary?

500

Decision to accept or deny a claim by the statutory due date or by _____________days from receipt of the claim whichever is sooner?

What is 14?

500
Directions that indicate when notification, concurrence or authorization is necessary in order to process an increase in reserves. Some are set at the standard limit of $20,000 while others may require notice for lower amounts.

What is Special Service Instructions?

500

What is to be updated when the case facts change?

What is the Resolution Strategy?

500

The 7 fields and values required to be completed for NCCI reporting.

What are Loss of Earnings capacity, preexisting disability, type of settlement, discontinued TTD/TPD codes in Claim Overview and lump sum, reduction code, and voc rehab code in Bocomp?

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