Devin
What is the definition of occupying per the A30 policy contract?
In, upon, entering or alighting from the vehicle
Which of the following are Exclusions for PIP Coverage?
Occupants of a Motorcycle; DWI; participating in a race/speed test
An Injured Party took a taxi to the IME appointment and submitted receipts for $35. How much would we reimburse?
$35
When adding an employer to ATLAS, how should they be added to the claim?
Related Contact-Employer
If a bill is faxed directly to a PIP Examiner, what is the next step?
Forward the document to MBR as a KFI Request
How long does an Interested Party have to submit a claim for Replacement Benefits?
90 calendar days from the date of service
When denying a claim for a Policy Cancellation:
FPM Eligibility should be 'Not Eligible' and ABP status 'On’
What options do Interested Parties and Providers have if they wish to contest a denial?
File a State Complaint, Arbitration or Suit
If an Injured Party is treating with a General Practitioner for a minor back injury, which IME should be requested?
Orthopedic Surgery
When paying a Vendor Bill for a Peer, what expense line do we pay under?
Medical- MED PEER Review
Which reserve lines are used for Additional PIP (APIP) benefits?
Medical, Income Loss, All Other
A second verification request must be sent within ____ - ____ _____________days from the date the 1st verification request was sent.
31-40 calendar
What are two situations in which you would complete a PIP CPW?
Fatal Coverage Condition Codes; policy exclusions
An injured party is treating with physical therapy prescribed by a Physical Medicine and Rehabilitation doctor. They are not receiving injections. What IME specialty would we request?
Orthopedic Surgeon
An injured party missed less than 5 days from work due to injuries they sustained in the accident. What information could be used to reimburse the time missed from work
A copy of 2 paystubs, one from during the time missed and one from the pay period prior to the accident
Which of the following examples are acceptable forms of Written Notice:
Letter Of Representation, UM/UIM forms, Ambulance Call Sheet, NF2, Police Report
What does it mean to indemnify?
To return someone to the approximate financial condition they were in prior to the accident; no more and no less
What does NYS Regulation 68 say about Household help?
a) Such services must be actually performed for a charge
b) Services must be performed by a person who is not legally obligated to render them
c) Services ordinarily performed as part of a family relationship are generally excluded
What must written notice include?
Time, Identity and Injury of the Interested Party, Place, Circumstance
The Orthopedic IME report comes back with positive results to re-evaluate in 6-8 weeks with no additional physical therapy. What are your next steps?
Update the IME GRID, read the report and move it to the IME folder
According to PIP Basics, which three criteria must be met before a bill is considered payable?
Treatment must be medically necessary; injuries related to the accident and service reviewed for compliance with NYS Fee Schedule
What is an Assignment of Benefits?
The form an Interested Party signs to allow GEICO to pay the provider directly for medical treatment
When creating an Anchor, the date in the anchor line represents:
The Last Contact Date
Which is not a required element to update for Medicare?
Driver’s License Number
Where on a HCFA bill form could an examiner find the medical providers Federal Tax Identification Number (TIN)?
Box 25