North American Risk Services, Inc. Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS SPECIAL INVESTIGATION UNIT Expectation: Document the file upon referring the file to the special investigation unit. Example of note: Referral made to NARS SIU. VENDOR Expectation: Document the file upon referring the file to a vendor. *If using a vendor for medical management (except nurse case management), put a note in the file under the category Medical. This is required for all vendors. Example note: Assigning Streamline to the file to coordinate diagnostics for the injured worker. Our client, name, approved Streamline on 3/22/21. • If investigation vendor, the category is investigation. CLOSING NOTE Expectation: A closing note is required prior to closing a lost time file. Must communicate with the injured worker and employer upon closure of a claim. (If there is no initial communication with the injured worker, no closing communication is required.) Confirm the following before closing: (copy and paste into the file as a closing note). • The injured worker has been discharged from medical care and placed at MMI. • No future medical treatment is needed. • Any lost time has had indemnity payments issued, and notices sent timely. • It is confirmed that the outstanding medical billing has been paid. • Verified that all applicable state forms and EDI have been submitted if applicable. • The claim doesn’t involve a Medicare beneficiary. • The claim is resolved. • Legal bills paid. • Closing the file this date. AUTHORITY/AUTHORITY REQUESTED Example of note: The injured worker was involved in a fatal accident. According to account handling instructions, this is considered a significant loss and has been reported to Joe at the customer on this date. 26 27