Intact Insurance's workers compensation claims team provides superior service to employers and injured workers using a collaborative, proactive planning approach for each injured worker's claim.
Workers' compensation benefits in illinoisJohn Newquist
Workers' compensation in Illinois provides medical care, temporary disability benefits, and permanent disability benefits for workers injured on the job. It covers injuries that arise out of and in the course of employment. Benefits include payment of all necessary medical care, 66-2/3% of the employee's average weekly wage during periods of temporary total disability, benefits for permanent injuries such as disfigurement or loss of body parts, and vocational rehabilitation if the employee cannot return to their previous job.
Timely injury reporting is a must! This webinar will cover the steps to follow in the event of a work place injury including an overview of the forms in your AlphaStaff Risk Kit. A few of the topics that will be covered are:
How to report the injury to AlphaStaff.
How to complete the necessary paperwork.
Understanding the claims handling process.
The document outlines procedures for reporting and handling employee injuries that occur at the Orange County Animal Care Services (OCACS). It states that any injured employee must immediately notify their supervisor, and the supervisor will ensure forms are completed and medical care is provided if needed. It provides details on the specific forms used, responsibilities of employees and supervisors, and requirements for reporting and documentation of injuries.
The document outlines the steps to take if injured at work: 1) Seek medical treatment immediately. 2) Tell your employer about the injury as soon as possible and fill out an injury report within 30 days. 3) Fill out and submit a worker's injury claim form to your employer to receive compensation benefits. Benefits may include medical costs, weekly wage payments if unable to work, and a lump sum for permanent impairment. The most important part of recovery is actively participating in treatment and communicating with your doctor and employer.
CFOs, HR Managers, and Business owners can use this simple guide to understand the simple techniques necessary to lower their overall cost of workers compensation insurance and provide a better outcome for injured workers. The secret: it takes work.
This document outlines the details of an employee group health insurance scheme, including:
1) Coverage amounts for natural death, accidental death, and permanent disability ranging from Rs. 15 lacs to Rs. 100 lacs depending on the employee's role.
2) Eligibility requirements, premium payment structure, claim settlement process, and exclusions from coverage such as pre-existing conditions or HIV/AIDS.
3) Benefit limits for in-patient hospital expenses including room rent, ICU costs, and other treatment, with higher limits for more senior employees.
Claims Processing & Administration in General InsuranceAjibola Ibukunolu
This document is a term paper on claims processing and administration in general insurance. It discusses key terms related to claims management, the typical claims procedure, and the importance of effective claims management for insurance companies. The claims procedure involves claim notification, inspection, appointing a loss adjuster, generating reports, communicating the settlement or repudiation, resolving disputes, delivering settlement, retrieving salvage, and applying contribution and subrogation. Good claims management is important as it improves customer satisfaction, reduces advertising costs, changes public perceptions of insurance, and attracts more customers and economic benefits.
The document summarizes the Employees' State Insurance (ESI) scheme in India. The key points are:
1) The ESI scheme provides social insurance benefits like sickness, maternity, disability and death benefits to employees earning 21,000 rupees or less per month.
2) Employers contribute 3.25% of salaries while employees contribute 0.75% towards medical care, cash benefits and other services provided through ESI hospitals, dispensaries and panel clinics across India.
3) Benefits include comprehensive medical care, cash benefits for sickness, maternity and disablement, dependents' benefits and funeral expenses. Insured persons and their families are entitled to these benefits by presenting their
Workers' compensation benefits in illinoisJohn Newquist
Workers' compensation in Illinois provides medical care, temporary disability benefits, and permanent disability benefits for workers injured on the job. It covers injuries that arise out of and in the course of employment. Benefits include payment of all necessary medical care, 66-2/3% of the employee's average weekly wage during periods of temporary total disability, benefits for permanent injuries such as disfigurement or loss of body parts, and vocational rehabilitation if the employee cannot return to their previous job.
Timely injury reporting is a must! This webinar will cover the steps to follow in the event of a work place injury including an overview of the forms in your AlphaStaff Risk Kit. A few of the topics that will be covered are:
How to report the injury to AlphaStaff.
How to complete the necessary paperwork.
Understanding the claims handling process.
The document outlines procedures for reporting and handling employee injuries that occur at the Orange County Animal Care Services (OCACS). It states that any injured employee must immediately notify their supervisor, and the supervisor will ensure forms are completed and medical care is provided if needed. It provides details on the specific forms used, responsibilities of employees and supervisors, and requirements for reporting and documentation of injuries.
The document outlines the steps to take if injured at work: 1) Seek medical treatment immediately. 2) Tell your employer about the injury as soon as possible and fill out an injury report within 30 days. 3) Fill out and submit a worker's injury claim form to your employer to receive compensation benefits. Benefits may include medical costs, weekly wage payments if unable to work, and a lump sum for permanent impairment. The most important part of recovery is actively participating in treatment and communicating with your doctor and employer.
CFOs, HR Managers, and Business owners can use this simple guide to understand the simple techniques necessary to lower their overall cost of workers compensation insurance and provide a better outcome for injured workers. The secret: it takes work.
This document outlines the details of an employee group health insurance scheme, including:
1) Coverage amounts for natural death, accidental death, and permanent disability ranging from Rs. 15 lacs to Rs. 100 lacs depending on the employee's role.
2) Eligibility requirements, premium payment structure, claim settlement process, and exclusions from coverage such as pre-existing conditions or HIV/AIDS.
3) Benefit limits for in-patient hospital expenses including room rent, ICU costs, and other treatment, with higher limits for more senior employees.
Claims Processing & Administration in General InsuranceAjibola Ibukunolu
This document is a term paper on claims processing and administration in general insurance. It discusses key terms related to claims management, the typical claims procedure, and the importance of effective claims management for insurance companies. The claims procedure involves claim notification, inspection, appointing a loss adjuster, generating reports, communicating the settlement or repudiation, resolving disputes, delivering settlement, retrieving salvage, and applying contribution and subrogation. Good claims management is important as it improves customer satisfaction, reduces advertising costs, changes public perceptions of insurance, and attracts more customers and economic benefits.
The document summarizes the Employees' State Insurance (ESI) scheme in India. The key points are:
1) The ESI scheme provides social insurance benefits like sickness, maternity, disability and death benefits to employees earning 21,000 rupees or less per month.
2) Employers contribute 3.25% of salaries while employees contribute 0.75% towards medical care, cash benefits and other services provided through ESI hospitals, dispensaries and panel clinics across India.
3) Benefits include comprehensive medical care, cash benefits for sickness, maternity and disablement, dependents' benefits and funeral expenses. Insured persons and their families are entitled to these benefits by presenting their
The document provides best practices for handling complex liability claims, including gathering important insurance and accident details from patients at registration, properly classifying and documenting claims, submitting complete documentation and bills to insurance companies, and understanding the insurance adjudication and payment processes which may involve various pricing methods, utilization review, and potential denials or exceptions. Following the guidelines can help facilities maximize reimbursements on liability claims.
At Religare Health Insurance, our guiding principal is to ensure that our customers enjoy quick and hassle free access to best-in-class healthcare delivery facilities and their claim process is easy!
This document outlines 10 steps for improving medical accounts receivable management: 1) establish clear financial policies, 2) verify insurance, 3) ensure accurate patient registration, 4) collect copays and balances, 5) thoroughly document services, 6) submit correct claims, 7) monitor reimbursements, 8) address denied claims, 9) invoice patients, and 10) pursue collections or write-offs. Following these steps helps maximize reimbursements and collections while minimizing accounts receivable. Charts are also provided showing indicators for aging receivables and key financial ratios related to receivables management.
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
Submitting clean claims will ensure timely and accurate insurance reimbursements. Clean claims will ensure that you are not wasting your staffs’ time on reworking insurance claims. As per definition, a clean claim is a submitted claim without any errors or other issues, including incomplete documentation.
Submitting clean claims will ensure timely and accurate insurance reimbursements. Clean claims will ensure that you are not wasting your staffs’ time on reworking insurance claims. As per definition, a clean claim is a submitted claim without any errors or other issues, including incomplete documentation.
Mediclaim policy of max bupa health insuranceHEETA SACHDEVA
Max Bupa offers various health insurance policies including Mediclaim. Mediclaim provides health coverage up to the sum insured for hospitalization due to illness or accident. It is issued for a specific time period and must be renewed for continued benefits. Max Bupa was formed through a partnership between Bupa and Max India to be a leading health insurance provider in India. Their policies cover medical expenses during hospitalization for treatment and reimburse medical charges due to illness.
This document provides guidelines for efficiently processing insurance claims at HearingLife. It outlines the important steps of intake, entering accurate patient information into Pinnacle, verifying insurance benefits, and following rules for submitting claims. When claims are rejected, the biller notes errors in Pinnacle. EOBs can be found in SharePoint. Patient balances should be tracked and addressed through statements and demand letters following HearingLife's collection protocol. Accurately following these guidelines ensures timely insurance payments.
Billing Basics for Mental Health Professionals (1 CE Credit)Procentive
Practicing psychologist Richard Sethre, Psy.D., L.P. and Marjie Brinkman, Director of BillCare, combine real world experience and industry knowledge for an informative and practical presentation outlining key billing concepts and issues. They will help you understand how claims are created by billing services, how claims are processed by insurance companies, and how you should respond when there are problems like denials or other payment issues.
Unless you stay current on billing issues and love doing it, this webinar will help you… a busy professional who provides great care but also knows that getting paid for it is pretty important.
Watch the presentation & get continuing education credits here. https://procentive.com/billing-basics/
The document provides guidelines for efficiently processing insurance claims at HearingLife. It outlines the important steps of intake, entering accurate patient information into Pinnacle, verifying insurance benefits, and following rules for submitting claims. When claims are rejected, the biller notes errors in Pinnacle. EOBs can be found in SharePoint. Patient balances should be tracked and addressed following the HearingLife collection protocol of statements and demand letters over 90 days before potential write-off or collections. Accurate information handling is crucial for timely insurance payments.
The document provides guidelines for efficiently processing insurance claims at HearingLife. It outlines important steps like collecting accurate patient information, inputting it correctly into Pinnacle, verifying insurance benefits, and following rules for claim submission. When claims are rejected, the biller must be notified to resubmit. EOBs can be found in SharePoint. Patient balances should be tracked and addressed following the HearingLife collection protocol. Accurate information handling at intake and in Pinnacle is critical for timely insurance payouts.
This document discusses the life cycle of an insurance claim, including:
1) Processing the CMS-1500 claim form by transferring information from medical records. Providers can accept assignment to be reimbursed directly by the insurance company.
2) Managing patients by verifying insurance information, generating encounter forms, and collecting copayments. Primary and secondary insurance is determined.
3) Submitting claims electronically or manually. Claims are processed, adjudicated by comparing to benefits and edits, and then paid or denied with an explanation of benefits sent.
This document provides a 6-step workflow for medical office claims reimbursement: 1) Prepare new patients with necessary documentation; 2) Verify patient insurance coverage and benefits; 3) Obtain required authorizations; 4) Collect charges and file claims correctly; 5) Post payments and address non-payments; 6) Aggressively work accounts receivables to maintain cash flow. Following these steps ensures complete documentation, proper billing, and timely reimbursement. The Iridium Suite practice management software supports the workflow with features like eligibility checking, electronic billing, and automated payment posting.
This document provides an overview of the physician professional claims and billing process. It describes the key steps from scheduling an appointment to claim adjudication and payment. These include patient registration, the medical visit, medical transcription and coding, claim generation and submission, claim processing by the insurance company, explanations of benefits, and payments to providers. Fraud and abuse prevention in coding and billing is also discussed. The overall process aims to accurately capture services rendered for proper reimbursement according to insurance rules and regulations.
Evelyn Torio has over 15 years of experience in the healthcare industry working in customer service and account management roles. She is currently an Account Representative Specialist at Palo Alto Medical Foundation, where she resolves complex billing and payment issues, ensures compliance with regulations, and updates patient accounts. Previously she held roles as an Imaging Service Representative and Customer Service Representative at other healthcare organizations. She aims to apply her technical and interpersonal skills to provide quality customer service and support a company in the healthcare industry.
Patient Collections - Optimizing Collections Before, During, and After the VisitKareo
Many practices go through the motions of getting a signed financial policy from a patient, verifying eligibility and even sending out statement after statement for a balance that wasn’t collected at the time of service. Unfortunately, when the time comes to ask for payment at the conclusion of a visit, the process falls apart. Having financial policies in place doesn’t do any good if they are not consistently followed and routinely reviewed.
The time to collect patient copays and past due balances is when a patient is standing in front of you. The resources required to collect once a patient has left the office increase and the chances of collecting the full balance owed decrease almost proportionately. With a little consistency and communication, practices can improve their collection rates dramatically.
This webinar will cover:
-Preparing your collections tools prior to the visit
Collecting estimated responsibility according to contract guidelines.
-Discussing finances with patients - should providers be involved?
-Reducing days in A/R after the visit.
This document provides tips for improving revenue cycle management in 2020. It discusses having a dedicated team of skilled billers and coders, verifying insurance eligibility and benefits, managing denials effectively, utilizing the latest technologies, and outsourcing revenue cycle management. Outsourcing to a company like MGSI can help physicians and practices improve their revenue cycle management and cash flow through MGSI's experienced billing team and latest technology solutions.
Easy Steps To Follow In Medical Billing Process.pptxRichard Smith
A well-organized practice require proper financial resources to make sure not only the delivery of medical services to the patients but payment to the providers and support staff, and also payment of overheads.
Industrial Tech SW: Category Renewal and CreationChristian Dahlen
Every industrial revolution has created a new set of categories and a new set of players.
Multiple new technologies have emerged, but Samsara and C3.ai are only two companies which have gone public so far.
Manufacturing startups constitute the largest pipeline share of unicorns and IPO candidates in the SF Bay Area, and software startups dominate in Germany.
The document provides best practices for handling complex liability claims, including gathering important insurance and accident details from patients at registration, properly classifying and documenting claims, submitting complete documentation and bills to insurance companies, and understanding the insurance adjudication and payment processes which may involve various pricing methods, utilization review, and potential denials or exceptions. Following the guidelines can help facilities maximize reimbursements on liability claims.
At Religare Health Insurance, our guiding principal is to ensure that our customers enjoy quick and hassle free access to best-in-class healthcare delivery facilities and their claim process is easy!
This document outlines 10 steps for improving medical accounts receivable management: 1) establish clear financial policies, 2) verify insurance, 3) ensure accurate patient registration, 4) collect copays and balances, 5) thoroughly document services, 6) submit correct claims, 7) monitor reimbursements, 8) address denied claims, 9) invoice patients, and 10) pursue collections or write-offs. Following these steps helps maximize reimbursements and collections while minimizing accounts receivable. Charts are also provided showing indicators for aging receivables and key financial ratios related to receivables management.
A comprehensive view of how Medical Billing works. How to prepare medical claims, patient eligibility, example insurance cards, Medicare / Medicade, authorization of services, charge entry, fee schedules, claim submissions, posting ERAs / EOBs, rejected or denied claims (and their correction), secondary claims, cycle of a claim, revenue cycle, provider info needed on a claim, evaluation and management: coding and evaluations and basic components, etc,. By Medwave Medical Billing & Credentialing at http://medwave.io.
Submitting clean claims will ensure timely and accurate insurance reimbursements. Clean claims will ensure that you are not wasting your staffs’ time on reworking insurance claims. As per definition, a clean claim is a submitted claim without any errors or other issues, including incomplete documentation.
Submitting clean claims will ensure timely and accurate insurance reimbursements. Clean claims will ensure that you are not wasting your staffs’ time on reworking insurance claims. As per definition, a clean claim is a submitted claim without any errors or other issues, including incomplete documentation.
Mediclaim policy of max bupa health insuranceHEETA SACHDEVA
Max Bupa offers various health insurance policies including Mediclaim. Mediclaim provides health coverage up to the sum insured for hospitalization due to illness or accident. It is issued for a specific time period and must be renewed for continued benefits. Max Bupa was formed through a partnership between Bupa and Max India to be a leading health insurance provider in India. Their policies cover medical expenses during hospitalization for treatment and reimburse medical charges due to illness.
This document provides guidelines for efficiently processing insurance claims at HearingLife. It outlines the important steps of intake, entering accurate patient information into Pinnacle, verifying insurance benefits, and following rules for submitting claims. When claims are rejected, the biller notes errors in Pinnacle. EOBs can be found in SharePoint. Patient balances should be tracked and addressed through statements and demand letters following HearingLife's collection protocol. Accurately following these guidelines ensures timely insurance payments.
Billing Basics for Mental Health Professionals (1 CE Credit)Procentive
Practicing psychologist Richard Sethre, Psy.D., L.P. and Marjie Brinkman, Director of BillCare, combine real world experience and industry knowledge for an informative and practical presentation outlining key billing concepts and issues. They will help you understand how claims are created by billing services, how claims are processed by insurance companies, and how you should respond when there are problems like denials or other payment issues.
Unless you stay current on billing issues and love doing it, this webinar will help you… a busy professional who provides great care but also knows that getting paid for it is pretty important.
Watch the presentation & get continuing education credits here. https://procentive.com/billing-basics/
The document provides guidelines for efficiently processing insurance claims at HearingLife. It outlines the important steps of intake, entering accurate patient information into Pinnacle, verifying insurance benefits, and following rules for submitting claims. When claims are rejected, the biller notes errors in Pinnacle. EOBs can be found in SharePoint. Patient balances should be tracked and addressed following the HearingLife collection protocol of statements and demand letters over 90 days before potential write-off or collections. Accurate information handling is crucial for timely insurance payments.
The document provides guidelines for efficiently processing insurance claims at HearingLife. It outlines important steps like collecting accurate patient information, inputting it correctly into Pinnacle, verifying insurance benefits, and following rules for claim submission. When claims are rejected, the biller must be notified to resubmit. EOBs can be found in SharePoint. Patient balances should be tracked and addressed following the HearingLife collection protocol. Accurate information handling at intake and in Pinnacle is critical for timely insurance payouts.
This document discusses the life cycle of an insurance claim, including:
1) Processing the CMS-1500 claim form by transferring information from medical records. Providers can accept assignment to be reimbursed directly by the insurance company.
2) Managing patients by verifying insurance information, generating encounter forms, and collecting copayments. Primary and secondary insurance is determined.
3) Submitting claims electronically or manually. Claims are processed, adjudicated by comparing to benefits and edits, and then paid or denied with an explanation of benefits sent.
This document provides a 6-step workflow for medical office claims reimbursement: 1) Prepare new patients with necessary documentation; 2) Verify patient insurance coverage and benefits; 3) Obtain required authorizations; 4) Collect charges and file claims correctly; 5) Post payments and address non-payments; 6) Aggressively work accounts receivables to maintain cash flow. Following these steps ensures complete documentation, proper billing, and timely reimbursement. The Iridium Suite practice management software supports the workflow with features like eligibility checking, electronic billing, and automated payment posting.
This document provides an overview of the physician professional claims and billing process. It describes the key steps from scheduling an appointment to claim adjudication and payment. These include patient registration, the medical visit, medical transcription and coding, claim generation and submission, claim processing by the insurance company, explanations of benefits, and payments to providers. Fraud and abuse prevention in coding and billing is also discussed. The overall process aims to accurately capture services rendered for proper reimbursement according to insurance rules and regulations.
Evelyn Torio has over 15 years of experience in the healthcare industry working in customer service and account management roles. She is currently an Account Representative Specialist at Palo Alto Medical Foundation, where she resolves complex billing and payment issues, ensures compliance with regulations, and updates patient accounts. Previously she held roles as an Imaging Service Representative and Customer Service Representative at other healthcare organizations. She aims to apply her technical and interpersonal skills to provide quality customer service and support a company in the healthcare industry.
Patient Collections - Optimizing Collections Before, During, and After the VisitKareo
Many practices go through the motions of getting a signed financial policy from a patient, verifying eligibility and even sending out statement after statement for a balance that wasn’t collected at the time of service. Unfortunately, when the time comes to ask for payment at the conclusion of a visit, the process falls apart. Having financial policies in place doesn’t do any good if they are not consistently followed and routinely reviewed.
The time to collect patient copays and past due balances is when a patient is standing in front of you. The resources required to collect once a patient has left the office increase and the chances of collecting the full balance owed decrease almost proportionately. With a little consistency and communication, practices can improve their collection rates dramatically.
This webinar will cover:
-Preparing your collections tools prior to the visit
Collecting estimated responsibility according to contract guidelines.
-Discussing finances with patients - should providers be involved?
-Reducing days in A/R after the visit.
This document provides tips for improving revenue cycle management in 2020. It discusses having a dedicated team of skilled billers and coders, verifying insurance eligibility and benefits, managing denials effectively, utilizing the latest technologies, and outsourcing revenue cycle management. Outsourcing to a company like MGSI can help physicians and practices improve their revenue cycle management and cash flow through MGSI's experienced billing team and latest technology solutions.
Easy Steps To Follow In Medical Billing Process.pptxRichard Smith
A well-organized practice require proper financial resources to make sure not only the delivery of medical services to the patients but payment to the providers and support staff, and also payment of overheads.
Similar to Workers Compensation Claims Services (20)
Industrial Tech SW: Category Renewal and CreationChristian Dahlen
Every industrial revolution has created a new set of categories and a new set of players.
Multiple new technologies have emerged, but Samsara and C3.ai are only two companies which have gone public so far.
Manufacturing startups constitute the largest pipeline share of unicorns and IPO candidates in the SF Bay Area, and software startups dominate in Germany.
Anny Serafina Love - Letter of Recommendation by Kellen Harkins, MS.AnnySerafinaLove
This letter, written by Kellen Harkins, Course Director at Full Sail University, commends Anny Love's exemplary performance in the Video Sharing Platforms class. It highlights her dedication, willingness to challenge herself, and exceptional skills in production, editing, and marketing across various video platforms like YouTube, TikTok, and Instagram.
The Evolution and Impact of OTT Platforms: A Deep Dive into the Future of Ent...ABHILASH DUTTA
This presentation provides a thorough examination of Over-the-Top (OTT) platforms, focusing on their development and substantial influence on the entertainment industry, with a particular emphasis on the Indian market.We begin with an introduction to OTT platforms, defining them as streaming services that deliver content directly over the internet, bypassing traditional broadcast channels. These platforms offer a variety of content, including movies, TV shows, and original productions, allowing users to access content on-demand across multiple devices.The historical context covers the early days of streaming, starting with Netflix's inception in 1997 as a DVD rental service and its transition to streaming in 2007. The presentation also highlights India's television journey, from the launch of Doordarshan in 1959 to the introduction of Direct-to-Home (DTH) satellite television in 2000, which expanded viewing choices and set the stage for the rise of OTT platforms like Big Flix, Ditto TV, Sony LIV, Hotstar, and Netflix. The business models of OTT platforms are explored in detail. Subscription Video on Demand (SVOD) models, exemplified by Netflix and Amazon Prime Video, offer unlimited content access for a monthly fee. Transactional Video on Demand (TVOD) models, like iTunes and Sky Box Office, allow users to pay for individual pieces of content. Advertising-Based Video on Demand (AVOD) models, such as YouTube and Facebook Watch, provide free content supported by advertisements. Hybrid models combine elements of SVOD and AVOD, offering flexibility to cater to diverse audience preferences.
Content acquisition strategies are also discussed, highlighting the dual approach of purchasing broadcasting rights for existing films and TV shows and investing in original content production. This section underscores the importance of a robust content library in attracting and retaining subscribers.The presentation addresses the challenges faced by OTT platforms, including the unpredictability of content acquisition and audience preferences. It emphasizes the difficulty of balancing content investment with returns in a competitive market, the high costs associated with marketing, and the need for continuous innovation and adaptation to stay relevant.
The impact of OTT platforms on the Bollywood film industry is significant. The competition for viewers has led to a decrease in cinema ticket sales, affecting the revenue of Bollywood films that traditionally rely on theatrical releases. Additionally, OTT platforms now pay less for film rights due to the uncertain success of films in cinemas.
Looking ahead, the future of OTT in India appears promising. The market is expected to grow by 20% annually, reaching a value of ₹1200 billion by the end of the decade. The increasing availability of affordable smartphones and internet access will drive this growth, making OTT platforms a primary source of entertainment for many viewers.
At Techbox Square, in Singapore, we're not just creative web designers and developers, we're the driving force behind your brand identity. Contact us today.
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2. Why Intact Insurance Specialty Solutions?
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The workers compensation claims team provides superior customer
service to employers and injured workers using a collaborative,
proactive planning approach for each injured worker’s claim. We
focus on positive outcomes, which means prompt medical care,
return to work and proactive management of claim costs.
3. When An Injury Occurs
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• Ensure the injured worker seeks immediate medical attention, if necessary.
• Assist the injured worker in locating a medical provider from an Intact Preferred
Provider Organization (PPO), Medical Provider Network (MPN), or a designated
physician based on jurisdictional guidelines.
• Provide the injured worker with Intact contact and billing information for his/her
medical provider.
• Provide a pharmacy First Fill Card, which allows the initial prescription to be filled
without the out-of-pocket expense for the injured worker.
• Report the claim to Intact within 24 hours.
4. How to Report A Claim
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Online - www.intactspecialty.com
• 24/7 web-based claim reporting is a click away.
This feature helps streamline the claims process
and provides another alternative for efficient
claims reporting. You may register at any time for
online reporting to obtain a user ID and password.
By Phone
• For workers compensation 800.203.9600
• All other claims 877.248.3455
• The 24/7 Intact claims call center receives and
processes all new workers compensation claims.
Claims phoned into the 24/7 Call Center before 8
p.m. EST will be immediately assigned a claim
number.
• Interpreter services are available for assistance.
By Email
• For Workers Compensation Claims
wclosses@instactinsurance.com
• All other claims claims@intactinsurance.com
• When you have attachments to accompany a claim, email
reporting can be ideal. To submit a claim via email, you’ll
need to include an ACORD First Notice of Loss Form.
• Remember to report only one claim per email.
• The sender’s email confirmation will serve as the
acknowledgement that Intact has received the claim.
By Fax
• All workers compensation claims: 800.224.4416
• Only one claim should be submitted per fax transmission.
• The sender’s fax receipt will serve as confirmation that Intact
Insurance has received the claim
5. Claim Assignment
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• Claim acknowledgement letter will be sent via email or mail indicating assigned claim
number and adjuster.
• Claim and state required First Report of Injury is created and reported based on
jurisdictional requirements.
• Claim triaged by supervisor and assigned to an adjuster based on jurisdictional
expertise and claim severity.
• Initial claim contacts will be made within one business day.
6. Claim Handling
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Medical Only Claims
• Focus in on securing and processing medical bills
• Closure target 90 – 120 days
Indemnity, Complex Medical or Subrogation Claims
• Fully investigate claim
• Ensure the injured worker is receiving appropriate medical care
• Facilitate return to work in a transitional or full duty status
• Telephonic case managers or field case managers may be assigned to work with the
parties of a claim to ensure the injured worker achieves an optimal recovery and return
to work
• Maintain ongoing insured and employee communication until claim resolution achieved
Incident Only Claims
• Closure after the initial contacts have been made
7. How Intact Insurance Manages Claim Costs
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• PPO Network – All States access via
Genex Provider Pathways.
• California MPN automatic
participation in the Atlantic Special
Insurance Company-Select MPN
• Genex Texas HCN if elected uses
Genex Provider Pathway to access
providers.
• Optum- Pharmacy Benefit Manager
• First Fill Program
• All accepted claims will receive
a prescription card to use
throughout the course of the
claim.
• Hospital / provider / utilization bill
review
• Diagnostic, durable medical
equipment, physical therapy, home
health care preferred providers
• Nurse case management –
telephonic or field nurses
• Alternative Return to workprograms
• Catastrophic injury management
• Intact’s special investigations unit
• Intact subrogation specialist team
• California Staff Counsel
• Designated attorney panel
8. Claims Services
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Additional services offered by Intact Insurance to assist our insureds with the
management of their workers compensation claims:
• Special handling instructions
• Assistance with loss run requests
• Web-based access to claim history and loss runs via risk manager
• Telephonic claim reviews – available depending on claim frequency and severity
9. Our Focus: Communication and Collaboration
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We believe that building strong relationships with our insureds is critical. Workers
compensation claims are handled successfully when there is a mutual flow of information
between Intact Insurance and our insured.
10. Our Focus: Communication and Collaboration
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What we expect of our claims team
• Regular communication with all parties to the claim, including the injured worker, employer,
agent/broker, and medical providers
• Full and complete investigation of claims
• Manage claims to ensure that appropriate medical care is received and that the employee is
able to return to work as quickly as possible
• Proactive management of claim costs
What we ask of our insureds
• Prompt claim reporting
• Provide information the adjuster needs to complete the investigation and communicate any
new information as it is learned
• Explore return to work options for employees with restrictions
11. Questions?
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Thank You
Please direct any questions to:
Cindy Van Eyll
VP Workers Compensation Claims 952.852.0828
cvaneyll@intactinsurance.com