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FINANCIAL MANAGEMENT—32 Points <br /> 1. Reserves (8 Points) <br /> A comprehensive reserve analysis must be prepared and be included as part of the claim file <br /> within the following intervals: <br /> a. Within 10 days of the TPA's knowledge of a claim, <br /> b. Within 90 days of the TPA's knowledge of a claim, <br /> c. At 6 month intervals thereafter, as long as a claim remains open, and <br /> d. At any time, where in the TPA's professional judgment, a claim event has occurred <br /> requiring a reserve increase or decrease. <br /> 2. Medical Payments (8 Points) <br /> Medical reimbursement made on behalf of IRC must be in accordance with contracted rates <br /> or the Florida Fee Schedule. Medical reimbursement includes reimbursements for physician <br /> office visits, surgeries, pharmaceuticals,physical therapy, and other medical treatments. A <br /> random sampling of medical reimbursements paid for each claim file will be reviewed. <br /> 3. Indemnity Payments (8 Points) <br /> Determination of the injured employee's proper average weekly wage and compensation rate <br /> must be made within 10 days of TPA's receipt of the wage statement is required by <br /> Statute/Administrative Code. Thereafter, timely indemnity payments will be documented. <br /> 4. Expense Payments (8 Points) <br /> Appropriate use/management of support resources will be reviewed. This will include the <br /> use of all vendors/resources enlisted and paid as an allocated loss adjustment expense <br /> (ALAE) or a legal expense such as defense counsel, surveillance,translators,Medicare set- <br /> aside services, transportation services, etc. To the extent a preferred panel of providers of <br /> these services has been established by IRC, use of preferred providers and contracted rates <br /> will be reviewed. <br /> PROGRAM MANAGEMENT REVIEW <br /> REPORTING & COMMUNICATIONS —35 Points <br /> 1. Routine Meetings (15 Points) <br /> The TPA will establish and conduct routine meetings with the Risk Manager,or designee,to <br /> review progress of the program,review financial indicators of the program,review legislative <br /> issues relevant to the program and to discuss any open issues. Meetings will,as appropriate, <br /> include sub-contractors of the TPA involved in the program. Agendas will be developed in <br /> advance of the meetings and minutes of meetings will be kept. Attendance via <br /> teleconference meets this requirement. <br /> Page 27 <br />