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Flashcards in Misc Test Need To Know Deck (82)
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1

3 day waiting period def

three consecutive calendar days beginning with the first day the worker loses time or wages from work as a result of the compensable injury.

2

When is the 3 day waiting period payable? Which 2 circumstances?

- Hospitalized – confirmed and typically paid on 1st check
- Authorized TTD is authorized for a period of consecutive 14 days. (paid on the 2nd check)

3

What is needed before an adjust approves time loss?

Authorization: from MD, NP or Type B provider must verify the workers inability to return to work and then authorize time loss

4

When is time loss due to the worker?

by statute 14 days from EDOK
by SAIFs best practice its 13 days from EDOK

5

After first payment how often do, we pay time loss?

every 14 days

6

Which one is not a type A medical provider who can serve as an attending physician in a claim?

- MD
- Dr of osteopathic Medicine
- Oral and Maxillofacial surgery
- Nurse Practitioner (CORRECT)
- Podiatrist

7

Which of the following is not a type B

- Chiro
- Nat Path
- PA
- Cardiologist (CORRECT)

8

How many days of office visits can a Type B medical Provider provide medical services?

60 days or 18 office visits from the date of the first on the initial claim

9

How many days can a Type B Medical provider authorize time loss benefits?

30 days from the date of the first office visit on the initial claim

10

How many days can an authorized NP provide medical services

180 days from the date of the first visit on the initial claim.

11

How many days can an authorized NP authorize time loss benefits?

180 days

12

How many attending physicians can a worker have during the life of a claim?

three

13

How many AP can be in a claim at one time?

One

14

How many days do insurers have to pay medical bills in an accepted claim?

45 days from the receipt of the bill

15

How many days do insurers have to pay medical bills that were received prior to a claim decision once the claims have been accepted?

14 days of the accept

16

How many days do insurers have to pay workers reimbursement?

30 days

17

How many days prior to the IME do the adjuster need to let the IW know of the scheduled appt?

10 days

18

An Exam with multiple IME examiners completed within 72 hours will be considered one IME Exam

true

19

Injury

Material or Major need for treatment/ disability

20

OD

Major cause of condition

21

Major

we need a medical opinion

22

Material

We don't need a medical opinion

23

How Many days can an ER Dr authorize time loss beneifts?

14 days

24

How many days do insurers have to pay medical bills in accepted claim?

45 days from receipt of bill

25

Which type of type B med provider is able to rate impairment?

Chiropractor

26

What types of things can a worker request reimbursement for?

meals, lodging, prescriptions and potentially lost wages

27

How many days does an insurer have to respond in writing to a written request for diagnostic preautho?

within 14 days of receiving the request from the provider

28

SAIF current contracts with which MCOs

- Caremark comp(CMC)
- Kaiser on the job
- Majoris health systems

29

Who approves MCO to offer service to workers

DCBS

30

Types of Settlements for denied claims

DCS and STIP