Releases
What type of release is used for most TSOs?
General Release
What do we list in the Negotiation Theme section of the evaluation?
The facts of the injury/treatment/damages that we can use to assist us in our negotiations.
What is a milestone?
A disengagement point for each round of settlement negotiations
What tool do we use to look up fees for certain codes?
Look Up > Fee
What type of release is used for Protender evaluations?
Limited Liability Release
What does LNAV stand for?
Liability Navigator
True or False: You should elevate any demand received to your leader, regardless if it's the first demand or a counter.
True or False: We should include records with our bills when uploading to MDP.
False - MDP only needs bills with CPT and ICD codes on them. We should never attach records with the bills submitted. If there are no ICD codes on the bill, we must put them on the cover sheet.
Name the three types of parties that we should be releasing in our releases
Named Insured, Insured Vehicle Owner, Insured Vehicle Driver
Name the types of settlements that are not LNAV eligible
UM, fatality, protender, dental injury only, internal injury, disc injury with surgery, TSOs, less than 4 visits where only injs are soft tissue
When beginning negotiations, what figure should be the first offer?
The bottom of your range
What do we need in order to consider the charge for a DME?
Invoice showing the DME, amount, supplier information, serial number, etc.
True or False: We do not need to list ERD in our release as long as it's in the CCT letter
False - We should always list the ERD in the release.
What job aid do we use to locate meanings of CPT codes and questions to consider during MDP reviews?
Sentry Rules
True or False: When negotiating liens with a provider, a verbal agreement to reduce the lien is just as valid as receiving a written agreement.
False - We should always obtain a written agreement from the provider
When we are done reviewing a bill, what status should we set on that bill showing it's been reviewed?
"3rd Party - Rep Eval Complete"
What type of release do we use for a minor BI claim that was a full evaluation?
Parents General Release - With Indemnity
What information do we list in the Causation section of the evaluation?
What caused the injury? Does the force of impact align with the injury? Is it reasonable that the injury would result from the impact?
What is the term we use when we have a DUI or hit and run and are adding extra money into our settlement?
Additionals
True or False: All liens should be submitted to MDP, regardless of whether the bills within the lien have already been submitted.
False: If the bills within the lien are already uploaded to MDP, there is no need to re-upload the lien. This will result in duplicate bills in MDP.