HomeMy WebLinkAboutExhibit 4EXHIBIT B
PERFORMANCE STANDARDS
1) Claim Receipt and Recording (1 point per claim for compliance)
Provider will document all new claim information received from the City, and this information will be
available electronically within one (1) hour of receipt, if received during normal business hours, or within
the first business hour of the next business day, if received less than one (1) hour before the close of a
business day. File will include completed First Report of Injury form.
2) Two or Three Point Contact by Claims Adjuster Within 24 Hours or next business day of
Claim Receipt
(3 points per claim for compliance —1 point for claimant(s) contact attempt; 1 point for
supervisor contact attempt, where applicable - if "not applicable," 1 point assigned; 1
point for treating provider contact attempt, where applicable — if "not applicable," 1
point assigned)
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A minimum of "three attempts" by the claims adjuster to contact the appropriate parties will be
considered a "contact," if followed up with appropriate correspondence within the measurement period.
For a workers' compensation claim, three (3) point contact will be required (claimant, supervisor and
treating provider). For a liability claim, two (2) point contact will be required (claimant and reporting City
supervisor, if applicable).
3) Document Subrogation Recovery Potential (1 point per claim for compliance)
Adjusters regularly will document and give Administrator written notice of, subrogation, contribution,
and/or coordination of benefits recovery potential. If Provider decides not to pursue any such recovery, it
must give written notice to the Administrator of its decision within fourteen (14) days of claim receipt.
4) Compensability Determination/Direction Within Fourteen (14) Days of Claim Receipt (1
point per claim for compliance)
For workers' compensation claims, within fourteen (14) days of receipt of the claim, the claims adjuster
will document compensability analysis findings.
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 ease.
5) Establishment of Reserves (2 points per claim for compliance —1 point for appropriate
reserve reviews and 1 point for appropriate Administrator's approval of reserve changes)
Within 72 hours of receipt of the claim, initial reserves for the file will be set; thereafter, reserves will be
reviewed on an on-going basis, as follows:
30 days from 72 hour review;
30 days from 30 day review;
60 days from last 60 day review; and
Every 6 months thereafter
Increase or Decrease of reserves by $10,000 or more, requires notification to the Administrator.
Subsequent to notification, the Administrator reserves the right to discuss the case and request a
reconsideration of the reserve with the Provider.
6) Rapid Response to Litigation Complaints (1 point for compliance — if "not applicable," 1
point assigned)
Claims adjusters will "address" litigation within two (2) days of receipt of litigation notification.
This will mean notice to the Administrator, and referral to the City Attorney's office for
assignment, within two (2) days.
7) Timely Preparation of Status Reports to the Risk Management Administrator or Designee
(3 points total for compliance, 1 point for each required status report, if only one
report required at time of review, 3 points assigned)
Required status reports were presented to the Risk Management Administrator or designee.
Required status reports are outlined in Attachment A, Scope of Services, Reporting Requirements
and Status Reports.