Claim Review #1
Y990
What is civilian activity done for income or pay?
When an accident happens strictly due to work
What is causally?
When a member is self employed
When is work comp insurance not required?
"Do you have an attorney?"
What is the first question you ask if a member says they have a WC accident?
"Please call us back when you have more information on you work comp claim."
What do you tell a member if they can't give you all the information related to a work comp accident?
EM OA & a date
What do we need to see on a Highview image to consider it a true work comp accident?
Occurs when an injured employee reaches a state where his or her condition cannot be improved
What is MMI?
We accept almost all denials for this group
What is FEP?
WC is primary over this
What is MVA?
Use two separate OPIS notes
What do you do in OPIS when you have a WC MVA?
Blue Card
Where can you find the SCCF number for a claim in OCWA?
Osteoarthritis
What type of arthritis do we deny for work comp?
Doctor, who has not previously been involved in a person’s care, examines an individual.
What is an IME?
Credit Balance
What is it called when a provider returns a check or advises us another insurance carrier paid?
Based on the injured body part
How do we determine a stop date for work comp?
OPL
What is one tab in blue squared you can view potential third-party insurance on?
Is abbreviated as NOIPLD
What is notice of insurer's primary liability determination?
Certificate of Release or Discharge from Active Duty
What is a DD214?
1 month to infinity
What is the date range for a work comp stop?
Deadlines to report a work comp
What are State Filing Limits?
Line level information in Highview
What is 2320 & 2430?
Client advocate Jessica Cahall
Who is the client advocate for the Canadian Pacific and Minnesota Railway?
We request this if a state outside of MN requires us to make a payment
What is a State Statute?
State filling is 3 years
What is Hawaii?
State filing is 120 days
What is Pennsyvania?