Medicare
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.
What has replaced the Injured Worker's Toolkit?
What is Injured Worker Portal?
What is within 5 business days?
The mechanism by which some customers can view Journal Entries.
What is Risktrac?
Tracy Ryan
Who is President, GRS North America?
Beneficiaries enrolled in both Medicare and Medicaid.
What is dually eligible beneficiaries?
Non-medical issues that can impede the injured worker's recovery; early indicators of high-risk, prolonged disability.
What are yellow flags?
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?
Information that should not be shared with any party outside of claims.
What is confidential information such as SSN, comorbids, etc?
Steve Deane.
Who is Chief Claims Officer, GRS North America?
Basis for prescription pricing for MSA.
What is AWP (Average Wholesale Pricing?)
Conditions that may impact the injured worker's recovery from a compensable injury?
What are comorbid conditions?
What is document in Journal Entry and follow up for receipt of repayment?
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?
What is Customer Centricity?
Injured worker is at MMI but MSA will project future treatment based on this standard.
What is standard of medical care for the diagnosis?
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?
A case that involves an injury that results in death, permanent total disability or lifetime permanent partial disability.
What is a life pension case?
What are abbreviations?
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?.
Reasonable expectation of being a Medicare beneficiary within 30 months of settlement and settlement payout is > $250k
What is a Class II Beneficiary?
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?
What is Special Service Instructions?
What is to be updated when the case facts change?
What is the Resolution Strategy?
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?