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2016-137
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2016-137
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Last modified
9/16/2016 11:37:49 AM
Creation date
9/16/2016 11:37:46 AM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
09/13/2016
Control Number
2016-137
Agenda Item Number
8.V.
Entity Name
Johns Eastern Company Inc.
Subject
Third Party Administration Services
Self Funded Worker's Compensation and Liability
Project Number
UPC 3228
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penalties will be credited to future amounts invoiced by the TPA to IRC. <br /> The Performance Reviews will measure objective performance standards which are easily identified <br /> and measured. After each Performance Review is performed,the TPA will meet with the IRC Risk <br /> Manager and/or designee to discuss initial evaluation results. The TPA will be given an opportunity <br /> to factually rebut the initial findings. Thereafter, a final tally of the review results will be prepared. <br /> A minimum Total Weighted Review Points of 80 is expected in the first annual period of the <br /> contract. The minimum Total Weighted Review Points is raised to 90 on the second annual period, <br /> and 95 for periods thereafter. Failure to meet these average compliance expectations will result in <br /> the penalty noted above. <br /> THIRD PARTY LIABILITY CLAIM FILE REVIEWS <br /> The Claim File Review will include 20 randomly selected claim files. The make-up of the files <br /> selected for each review will be at least 50%open files. At least 50%of the selected files will have <br /> recent(within performance period)dates of occurrence and remaining selected files will have dates <br /> of injury more than 12 months prior to the performance period. <br /> Each claim will generate a score ranging from 1 to 100 points. All timeliness standards of <br /> performance are stated in business, not calendar, days. In any instances where a standard is not <br /> applicable to a particular claim file,the file will be awarded the appropriate point(s)for that standard. <br /> Only transactions that are paid or processed during the performance period will be subject to scoring. <br /> 1. Claim Receipt, Recording & Contact Assigned (20 Points) <br /> The TPA will document claims intake information on all liability claims,enter the claim into <br /> the system,properly code claim,assign claim number and assign adjuster. This information <br /> will be available electronically within one business day of receipt of claim intake <br /> information. <br /> A minimum of"three attempts"by the claims adjuster to contact the appropriate claimant(s), <br /> employees,and/or supervisor will be considered a"contact,"if followed up with appropriate <br /> correspondence and documented in the file within the measurement period. <br /> 2. Document Subrogation Recovery Potential (10 Points) <br /> Adjusters will document subrogation,contribution,and/or coordination of benefits recovery <br /> potential in the claim file within fourteen (14) days of claim receipt. <br /> 3. Litigation Management and Communication/Documentation (10 Points) <br /> Claims adjusters will "address"litigation within two(2)days of litigation receipt. This will <br /> Page 23 <br />
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