AgdaPkt 2002-01-28 - Laserfiche WebLink

Browse Search

Fiscal Analysis 1. Maintain a computerized payment system as part of the claims tracking system to pay all benefits, medical costs, and other bills for services approved by the Client or required by law. 2. The Risk Management Information Systems (RMIS) Department will provide all mutually agreed upon reports and the Client may choose from any of the over 200 stock reports available at no extra cost. CMl will provide "incurred but not reported" (IBNR) and other projections for future fiscal years. 3. Assist the Client in establishing their own trust account for payments of benefits and services in a bank of their choice. 4. Maintain a trust account for paying benefits and expenses. 5. Provide copies of all checks, vouchers or warrants drawn by CMl if requested. 6. Provide a monthly check/voucher register of all transactions. 7. Submit a Trust Account reconciliation statement for reimbursement as needed during each month. Claim Procedures In coordination with the Client, and utilizing the best practices in adjudicating, setting reserves, paying, settling or denying claims, CMl will: 1. Assign a designated Examiner Team to the Client's account. All Client claims will be managed by this Team. 2. Maintain timely, clear, and accurate written, oral, and personal communications with the Client's designated contact person on all files. 3. Receive, review and process all industrial injury claims in compliance with all applicable laws, regulations and the Client's performance standards regarding workers' compensation benefits. 4. Establish three-point contact with the employee, physician and the Client's contact person(s) to obtain needed information to accurately establish compensability, assure proper treatment decisions, and attain prompt file closure. 5. Set up each claim file within twenty-four (24) hours of first notice, ensure early medical intervention and maintain an atmosphere of trust and professionalism in all claims to promote quick return to work, minimize litigation and promote early closure. 6. As authorized by the Client, perform the necessary analysis and investigations to assure claim validity. PAGE 7 CLAIMS MANAGEMENT, INC.