Workers’ Compensation Claims Handling Guidelines Medical Provider and Vendor Payments: • All non-disputed medical provider bills must be paid within 3 business days of bill audit approval and within 30 days of receipt. • All non-disputed vendor bills must be paid within 3 days of receipt of the invoice. Medicare: • The Workers' Compensation Claim Specialist will determine if the injured worker is Medicare eligible. Medicare's interest should always be considered, including but not limited to when settling a claim. All relevant information will be considered to determine if a Medicare Set Aside is needed and/or explore if a Conditional Payment Lien exists. If the injured worker is Medicare eligible, the Workers' Compensation Claim Specialist will provide the defense attorney with the correct release language. • The Workers' Compensation Claim Specialist must complete the required Medicare fields in the claims system on all claims. Subrogation: • Upon receipt of a claim, the Workers' Compensation Claim Specialist should evaluate for any possible third-party negligence such as defective equipment/product or third parties liable for injuries caused to the employees and document analysis in the claim file. When the Workers' Compensation Claim Specialist identifies potential subrogation, the Workers' Compensation Claim Specialist should send a referral to the subrogation unit (or preferred subrogation vendor per client) to review the file. • Upon review of the claim, the leader should determine if potential subrogation has been identified and referred accordingly per client direction. Second Injury Fund: • Identify if the state where benefits are being paid has a second injury fund available. File Documentation and Organization: • The Workers' Compensation Claim Specialist must maintain the integrity of every claim file, and the notes must be proactive, professional, and positive. Falsifying events or destroying or altering documents to falsify the record will not be tolerated. The file notes should reflect an accurate accounting of the accident/injury and provide the needed information to support the methods used in handling the claim. This document contains North American Risk Services – Workers’ Compensation proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services.