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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 />