VSDP and Workers Compensation Kitty Hughes Workers Compensation Services.
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Transcript of VSDP and Workers Compensation Kitty Hughes Workers Compensation Services.
VSDP and Workers’ Compensation
Kitty Hughes
Workers’ Compensation
Services
Program Overview GOAL
STD claims -Provide agency with VSDP coordinated approvals on occupational cases. LTD claims – Provide IWs with direct LTD benefits and supplemental benefits on occupational cases.
Reporting the claim• Workers’
Compensation• MC Innovations
– Submission via Visual Liquid Web by agency representative
– Mandatory submission by day 10 post injury
• VSDP• Reed Group
–Submitted by member or anyone on their behalf
–14 day look back from date reported
Workflow Process• New claim process
• Pending claim process
• Ongoing approval process
• Denied claim process
New Claim – WC/VSDP• Agency submits WC claim via VLW• Benefit Coordinator initiates WC investigation• IF IW initiates claim with Reed Group
– Reed Group sends Althea an email for information• Enters Reed Claim Number in WC system• Notes eligibility VSDP File (Yes) field• places DBS in responsibility tab• sets a diary for the BC• Enters a VSDP note in the claim system• Report generates to assigned DBS next business day
Althea adds Reed Claim Number
Adds VSDP Filed - Yes
Disability approval updated
Add the DBS Name
Sets a diary for follow up
Pending claim process
• Weekly review of WC file status on diary• WCS notifies Althea if comp decision is
made in between diary dates• Althea updates the VSDP status via
VSDP file note (for overnight transmission)
Reed processes disability claim while WCClaim remains in a WC Pending status
Ongoing disability approvals
• Disability approvals are scheduled by:– BC or Althea– Based on the next treating physician’s office
visit (NOV)– Anticipated length of disability– Claims activities on file (such as IME,
surveillance or vocational compliance)
Denied Claims
• Denied claim compensability – reported to Reed Group via VSDP daily report
Denied ongoing approvals based on:Settlement of claimFailure to cooperateRefusal of medicalDisability from unauthorized physician
Communication is the key
• Accurate facts
• Opportunities/options
• Optimal medical outcomes
• RTW facilitation
Agency Interaction
• Knowledge of process
• Who do you contact?– [email protected]
– Workers’ Compensation• Althea Burnett (804) 786-9862 [email protected]
What you can do to help
• Provide RTW updates to both TPA’s• Provide Wage and Supplemental Reports• Encourage IW to report claim to Reed
Group timely• Forward medical notes/disability slips• Track and share LTD date• Contact TPA if approval is inaccurate
Goal – Universe in Harmony