St. Pete Beach
What are some examples of passive therapy?
Hot/Cold Packs, Massage, Electric Stimulation, Whirlpool, Mechanical Traction
What are some examples of diagnostic tests?
MRIs, CT Scans, X-rays, EMG/NCVs
What items can be used to verify a DOL when reviewing a coverage issue?
PR, Ambulance Call Sheet, ER billing with Records, or by contacting a witness, driver of V2 or A/C
What are some common red flags for fraud?
CC95/99, CC33, older vehicle with a lot of PIP coverage on it, large gap between DOL & 1st day treating, single vehicle loss of control ax, insured denies involvement, ISO shows extensive list of prior injury claims, IP not listed on PR, injuries are inconsistent with the vehicle damage sustained, driver doesn’t know the name of other passengers in vehicle
What section in Atlas can coverage condition codes be reviewed & updated?
Policy & Coverages > Coverage Issues
For a soft tissue injury, during which phase is it typical to treat with ONLY passive therapies?
The Acute Inflammatory phase
What must you update in Parties Involved under the IP’s Additional Information Tab for new PIP assignments?
ISO Findings
What generates a CC33?
Endorsement on the Policy which was processed within 30 days of the loss date
What are the Medicare elements that we need to update our file.
First & Last Name
Cass Verified Address
Date of Birth
Gender
Social Security Number - last 5 SSN can be used
Accident - related ICD-10 code
Where are PIP CPWs & SIU Referrals submitted?
Referrals Tab
What is whiplash?
A cervical strain/sprain
What must be documented in Atlas for all prior injuries located in ISO?
DOL, A/C, type of loss, injury
How is a CC33 resolved?
Confirm the DOL, Review PEAK/EDGE Policy Viewer to find the endorsement and review if it effects PIP Coverage.
Is the examiner attempting to update Medicare eligibility and reporting information during each conversation with the IP or attorney?
If all information is not secured on the file, the examiner should be asking the IP or their attorney on every call / conversation.
Additionally, the information should be followed up on every 30 days.
How long do we have to TIP a new loss?
24 hrs
For which mechanism of injury is whiplash most likely to occur?
A rear-end collision
How and when do we need to verify permissive use?
When our IP is an unlisted driver -- we verify permission with the NI/CI
What status should a CCC be updated to if we confirm there is No Coverage due to a Fatal CC?
No Coverage
What is the diagnosis if an IP’s medical billing shows torn ligaments in their left knee?
Left knee sprain
How long to we have to respond to an INET (internet inquiry )
24 hrs