Medflow
What report in medflow tells us if treatment is pre certified
What is Phad denial
How is legal action brought upon us in New Jersey
What is arbitration
We go here to look at all the bills we have on file
What is first party medical
This determines whether a claim should be paid, denied, or defended under the policy.
What is coverage?
Where do we go to look at PHAD reports
What is Medflow
If we can't find a claim in medflow what most likely occurred
What is typing the wrong claim number in
This is where many NJ PIP disputes are resolved.
What is forthright
This checks if treatment is needed and appropriate.
What is medical necessity?
What happens to billing if coverage is exhausted?
What is billing is looked to be denied
This is used to challenge whether treatment is reasonable and necessary.
What is peer review
Where do we go to see if imes were conducted
What is eval services
What reserves lines do we use in litigation
What is attorney fees and costs/basic pip medical expense
These are your notes in the claim file.
What is notes
If policy wording is unclear, decisions often favor this person
What is the insured
You might settle if this becomes too high.
What is exposure or defense costs?
What tab in medflow gives a great breakdown of everything going on for the ip?
What is patient summary
When we make a decision on a bill we chose to do either of these things
What is settle/defend/withdraw
When doctors disagree, you must look at this to decide.
What is supports
Why is it important to verify PIP coverage before responding to a lawsuit?
To confirm whether the policy applies and defenses exist
If you don’t respond in time, you may lose by this.
What is default
What documents are crucial to have as supports for litigation
What is Phad report and ime report
This is the first step before deciding whether to settle or litigate a claim.
What is evaluating exposure
This is something unusual in a claim that may suggest a problem with treatment.
What is a red flag
This document tells you what is and is not covered under the claim.
What is insurance policy
You may choose to settle early if this continues to increase with litigation
What is exposure