AgdaPkt 2004-06-28 - Laserfiche WebLink

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c�.i �.c� . The TPA shall maintain direct contact with medical service providers to ensure their reports are received in a timely manner. The TPA shall arrange medical evaluations when needed, reasonable, and/or requested in compliance with the cunent Labor Code. The TPA shall ensure that medical bills are reduced to the recommended rates established by the Administrative Director of Workers' Compensation. The use of a service contractor is acceptable provided the City's approval is first obtained. The City shall pay for the use and benefits of the services provided. The TPA shall provide, at the City's expense, utilization review and/or professional managed care services on an as-needed basis to injured employees, provided the member city andlor the City's approval is obtained prior to the provision of such service. 8. Medical Pa, m� ents: Medical bills will be matched to the file, reviewed for correctness, approved for payment, and paid within time limits established by Labor Code section 4603.2. If all or part of the bill is being disputed, the TPA will notify the medical provider, on the appropriate form letter, within time limits established by Labor Code 4603.2. 9. Plan of Action: Each claim file shall contain the examiner's plan of action for the future handling of that claim. Such plan of action will be identified in the computer notepad. 10. Investi at� ion: The TPA shall subscribe to the Index Bureau. The examiner shall request a report from the Index Bureau on a11 new indemnity claims. Subsequent requests should be made every six (6) to twelve (12) months thereafter on all active indemnity claims. 11. Compensabili�: The compensability determination (accept claim, deny claim, or delay acceptance pending the results of additional investigation) and the reasons for such determination will be made and documented in the file within three (3) working days of the receipt of the notification of the loss. Delay or denial of benefit letters shall be mailed in compliance with the Division of Industrial Relations' guidelines. The TPA shall notify the member city of delay or denial of any claim. In no case shall a final compensability decision be extended beyond ninety (90) days from the member city's knowledge of the claim. 12. Provision of Benefits: The TPA shall provide all compensation and medical benefits in a timely manner and in compliance with the statutory requirements of the California Labor Code. The TPA shall compute and pay temporary disability benefits to injured employees based upon earnings information and authorized disability periods. The TPA shall review, compute, and pay all informal ratings, death benefits, Findings and Awards, life pensions, or Compromise and Release settlements. City of Redwood City - Performance Standards Page 3 of 8 July 1, 2004