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3. Reporting and Reimbursement of State of Florida Penalties (5 Points) <br />TPA will provide quarterly reporting to IRC of all penalties paid by the TPA to the State <br />of Florida. The report will include documentation of the reason for the penalty and describe <br />the responsibility. TPA will promptly reimburse IRC for penalties for which the TPA's <br />actions are responsible. <br />STAFFING — 20 Points <br />1. Caseloads (10 Points) <br />Average assigned caseloads for adjusters will not exceed 170 open claim files. Medical only <br />adjuster case load will not exceed 250 open claim files. <br />2. Communications Regarding Assigned Staff (10 Points) <br />TPA will provide notice to Risk Manager of all staff changes relating to the management of <br />IRC claims. <br />PROVIDER NETWORK EFFECTIVENESS —15 Points <br />1. Ability to Get Appointments Quickly (10 Points) <br />TPA agrees that it will design, establish, maintain and administer a provider network through <br />which treatment, services and supplies will be provided in a reasonably timely manner. TPA <br />agrees it will clearly document in the file any difficulties in obtaining timely treatment, <br />services or supplies and any and all efforts to procure alternatives to such treatment, services <br />or supplies. <br />2. Management of Non -Standard Fee Agreements (5 Points) <br />TPA will document all non-standard fee agreements for medical services. TPA agrees that <br />any and all non-standard fee agreements must be reviewed and approved by IRC prior to <br />receipt of treatment, services or supplies. TPA shall clearly document IRC's approval in <br />the file. <br />EXCESS INSURANCE — 30 Points <br />1. Reporting (10 Points) <br />TPA will provide documentation of compliance with all reporting requirements of excess <br />insurers. <br />2. Documentation of Appropriate Communications with Excess Insurers (10 Points) <br />All claim files with total incurred experience projections exceeding the self-insured <br />retention for date of injury will document appropriate communication with excess <br />insurance. All required and appropriate information will be provided to excess insurers. <br />3. Prompt Reimbursement of Excess Insurance (10 Points) <br />Page 28 <br />