A Day in the Life of a Claims Adjuster

transcript

8:00 am Monday I’ve been assigned a new claim…

Communicate and follow up with Doctor

800-555-1234hts@doctor.com

Communicate and follow up with

claimant

123-555-4567rj@claimant.com

Communicate and follow up with Attorney

800-555-5678jsr@attorney.com

*Disclaimer: Fictitious phone numbers and email addresses are used here.

8:30 am - Made calls to contact the claimant, doctor and attorney…

claimant

10:30 am - Contacted others involved with the claim while waiting on return calls…

Discharge Planner

800-555-3456tyu@dcp.com

Communicate and follow up with Field

Case Manager

800-555-6789iop@fcm.com

Communicate and follow up with Vendor

800-555-2345abc@vendor.com

claimant

Discharge Planner

800-555-3456tyu@dcp.com

Case Manager

800-555-6789iop@fcm.com

Locate Vendor to provide equipment

800-555-6987cdf@equip.com

Coordinate delivery of equipment

800-555-1479lac@delivery.com

Order additional supplies for equipment

800-555-3697bvn@supplies.com

Retrieve equipment

800-555-3214return@dme.com

12:30 pm – Located vendor and coordinated equipment delivery, but still have follow up calls…

Doctor

claimant

Attorney

Discharge Planner

800-555-3456tyu@dcp.com

Case Manager

800-555-6789iop@fcm.com

Retrieve equipment

2:30 pm – Just discovered the claimant needs transportation…

Locate Transportation

Vendor

ask@vendor.com800-555-6987

Schedule appointments for

claimant

sched@appt.com800-555-3697

Confirm/verifyaddresses

add@confirm.com800-555-7891

Doctor

claimant

Attorney

Discharge Planner

800-555-3456tyu@dcp.com

Case Manager

800-555-6789iop@fcm.com

Retrieve equipment

4:30 pm - AND home health care…

Vendor

claimant

Communicate with Home Health Agency

abc@care.com800-555-2345

Schedule, follow up & confirm appointments

Coordinate IV medications

ivcare@delivery.com800-555-1479

Doctor

claimant

Attorney

Discharge Planner

800-555-3456tyu@dcp.com

Case Manager

800-555-6789iop@fcm.com

Retrieve equipment

5:30 PM – Have not followed up on any of my other claims today! There has to be an easier way…

Vendor

claimant

Communicate with Home Health Agency

abc@care.com800-555-2345

Schedule, follow up & confirm appointments

Coordinate IV medications

ivcare@delivery.com800-555-1479

*Disclaimer: Fictitious phone numbers and email addresses are used here.Follow up with the invoicing and payment process.

800-547-3330www.modernmedical.com

We work harder to make your job easier, more efficient and cost-effective.

8:30 am Monday - I made a call to Modern Medical…

(800) 547-3330modernmedical.com

Pharmacy Benefit Management• First fill program/Retail pharmacy cards• Opioid Defense Manager™• Formulary Management• Medication Reviews:

- Drug Indication Report (DIR)- Basic Medication Review (BMR)- Independent Pharmaceutical

Evaluation (IPE)- Peer Review- Peer Review with IPE

P Durable Medical EquipmentP Orthotics & ProstheticsP Medical SuppliesP ElectrotherapyP Home & Vehicle ModificationsP Home Health ServicesP IV Infusion TherapyP Transportation ServicesP Translation Services

Modern Medical offers the following services:

Technology, Solutions, Service. Guaranteed!

P Communicate and Follow Up with Claimant P Locate Vendor to Provide EquipmentP Communicate and Follow Up with Attorney P Coordinate Delivery of EquipmentP Communicate and Follow Up with Field Case Manager P Order additional Supplies for EquipmentP Communicate and Follow Up with Discharge Planner P Retrieve equipmentP Communicate and Follow Up with Doctor P Communicate with UR/Bill ReviewP Communicate and Follow Up with TPAP Communicate and Follow Up with Vendor

In addition, Modern Medical provides:

P Utilization Management P Claimant progress reports

Ancillary@modernmedical.com

Durable Medical Equipment

P Communicate and Follow Up with Claimant P Locate Transportation vendorP Communicate and Follow Up with Attorney P Schedule appointments for ClaimantsP Communicate and Follow Up with Field Case Manager P Confirm/verify addressesP Communicate and Follow Up with Discharge Planner P Communicate with UR/Bill ReviewP Communicate and Follow Up with DoctorP Communicate and Follow Up with TPAP Communicate and Follow Up with Vendor

P Pre-appointment confirmation with Claimant P Confirm appointment with transportation providerP Facility arrival confirmation P Weekly notes

Transportation

P Communicate and Follow Up with Claimant P Locate Home Care AgencyP Communicate and Follow Up with Attorney P Coordinate IV medicationsP Communicate and Follow Up with Field Case Manager P Schedule, follow up & confirmP Communicate and Follow Up with Discharge Planner appointmentsP Communicate and Follow Up with Doctor P Order and coordinate delivery of suppliesP Communicate and Follow Up with TPA P Utilization managementP Communicate and Follow Up with Home Care Agency P Communicate with UR/Bill Review

P Monitoring of Claimant’s progress P Weekly notes P Handling special requests

Home Health Care

8:45 am Monday - I’m able to get on with my day and know that my claimant is in trusted hands.

A Day in the Life of a Claims Adjuster

Health & Medicine