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