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mean a referral to the appropriate legal counsel for assignment within two (2) days. 4. Direction Within Fourteen (14) Days of Claim Receipt (20 points) For liability claims, within fourteen (14) days of receipt of the claim, the claims adjuster will document appropriate specific direction for the investigation and handling of the case. 5. Reserves — Documentation, Routine/Appropriate Updates (20 Points) Within 72 hours of receipt of the claim, initial reserves for the file should be set; thereafter, reserves will be reviewed on an on-going basis, and, at a minimum of 30 days from 72 hour review, 30 days from 30 day review, 60 days from last 60 day review and every 6 months thereafter. Any increase or decrease of reserves by $10,000 or more requires notice to the Risk Manager, or designee. The file should document such notice when appropriate. 6. Excess Insurer Communication, Documentation and Recovery (20 Points) TPA will provide documentation of compliance with all reporting requirements of excess insurers. All claim files with total incurred experience projections exceeding self-insured retention for date of injury will document appropriate communication with excess insurance. All required and appropriate information will be provided to excess insurers. TPA will file for reimbursement from excess insurer for each claim file when total payments exceed self-insured retention. Initial filing for reimbursement will occur within 90 days of when total payments exceeded self-insured retention. TPA will follow-up with excess insurer every 90 days until all excess insurance reimbursements have been received by IRC. WORKERS' COMPENSATION CLAIM FILE REVIEWS The Claim File Review will include 50 randomly selected claim files. The make-up of the files selected for each review will be at least 50% open files. At least 50% of the selected files will have recent (within performance period) dates of injury and remaining selected files will have dates of injury prior to the beginning of the performance period. Each claim will generate a score from 1 to 100 points. All timeliness standards of performance are stated in business, not calendar, days. In any instances where a standard is not applicable to a particular claim file, the file will be awarded the appropriate point(s) for that standard. Only transactions that are paid or processed during the performance period will be subject to scoring. MEDICAL MANAGEMENT/CONTROL — 32 Points 1. Timely Medical Bills and Records (8 Points) The TPA will review bills, invoices, and other claims for payment submitted by health care providers to identify proper authorization, over utilization, underutilization and billing errors and will adjudicate/pay those bills and mail (postmark) payments within 45 days. Bills will be properly coded. Page 24