Flashcards in Misc Test Need To Know Deck (82)
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.
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)
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
When is time loss due to the worker?
by statute 14 days from EDOK
by SAIFs best practice its 13 days from EDOK
After first payment how often do, we pay time loss?
every 14 days
Which one is not a type A medical provider who can serve as an attending physician in a claim?
- Dr of osteopathic Medicine
- Oral and Maxillofacial surgery
- Nurse Practitioner (CORRECT)
Which of the following is not a type B
- Nat Path
- Cardiologist (CORRECT)
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
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
How many days can an authorized NP provide medical services
180 days from the date of the first visit on the initial claim.
How many days can an authorized NP authorize time loss benefits?
How many attending physicians can a worker have during the life of a claim?
How many AP can be in a claim at one time?
How many days do insurers have to pay medical bills in an accepted claim?
45 days from the receipt of the bill
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
How many days do insurers have to pay workers reimbursement?
How many days prior to the IME do the adjuster need to let the IW know of the scheduled appt?
An Exam with multiple IME examiners completed within 72 hours will be considered one IME Exam
Material or Major need for treatment/ disability
Major cause of condition
we need a medical opinion
We don't need a medical opinion
How Many days can an ER Dr authorize time loss beneifts?
How many days do insurers have to pay medical bills in accepted claim?
45 days from receipt of bill
Which type of type B med provider is able to rate impairment?
What types of things can a worker request reimbursement for?
meals, lodging, prescriptions and potentially lost wages
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
SAIF current contracts with which MCOs
- Caremark comp(CMC)
- Kaiser on the job
- Majoris health systems
Who approves MCO to offer service to workers