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A Day in the Life of a Claims Adjuster
8:00 am Monday I’ve been assigned a new claim…
Communicate and follow up with Doctor
Communicate and follow up with
claimant
Communicate and follow up with Attorney
*Disclaimer: Fictitious phone numbers and email addresses are used here.
8:30 am - Made calls to contact the claimant, doctor and attorney…
Communicate and follow up with Doctor
Communicate and follow up with
claimant
Communicate and follow up with Attorney
*Disclaimer: Fictitious phone numbers and email addresses are used here.
10:30 am - Contacted others involved with the claim while waiting on return calls…
Communicate and follow up with
Discharge Planner
Communicate and follow up with Field
Case Manager
Communicate and follow up with Vendor
Communicate and follow up with Doctor
Communicate and follow up with
claimant
Communicate and follow up with Attorney
*Disclaimer: Fictitious phone numbers and email addresses are used here.
Communicate and follow up with
Discharge Planner
Communicate and follow up with Field
Case Manager
Communicate and follow up with Vendor
Locate Vendor to provide equipment
Coordinate delivery of equipment
Order additional supplies for equipment
Retrieve equipment
12:30 pm – Located vendor and coordinated equipment delivery, but still have follow up calls…
Communicate and follow up with
Doctor
Communicate and follow up with
claimant
Communicate and follow up with
Attorney
Communicate and follow up with
Discharge Planner
Communicate and follow up with Field
Case Manager
Communicate and follow up with Vendor
Locate Vendor to provide equipment
Coordinate delivery of equipment
Order additional supplies for equipment
Retrieve equipment
2:30 pm – Just discovered the claimant needs transportation…
Locate Transportation
Vendor
Schedule appointments for
claimant
Confirm/verifyaddresses
*Disclaimer: Fictitious phone numbers and email addresses are used here.
Communicate and follow up with
Doctor
Communicate and follow up with
claimant
Communicate and follow up with
Attorney
Communicate and follow up with
Discharge Planner
Communicate and follow up with Field
Case Manager
Communicate and follow up with Vendor
Locate Vendor to provide equipment
Coordinate delivery of equipment
Order additional supplies for equipment
Retrieve equipment
4:30 pm - AND home health care…
Locate Transportation
Vendor
Schedule appointments for
claimant
Confirm/verifyaddresses
Communicate with Home Health Agency
Schedule, follow up & confirm appointments
Coordinate IV medications
*Disclaimer: Fictitious phone numbers and email addresses are used here.
Communicate and follow up with
Doctor
Communicate and follow up with
claimant
Communicate and follow up with
Attorney
Communicate and follow up with
Discharge Planner
Communicate and follow up with Field
Case Manager
Communicate and follow up with Vendor
Locate Vendor to provide equipment
Coordinate delivery of equipment
Order additional supplies for equipment
Retrieve equipment
5:30 PM – Have not followed up on any of my other claims today! There has to be an easier way…
Locate Transportation
Vendor
Schedule appointments for
claimant
Confirm/verifyaddresses
Communicate with Home Health Agency
Schedule, follow up & confirm appointments
Coordinate IV medications
*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
800-547-3330www.modernmedical.com
We work harder to make your job easier, more efficient and cost-effective.
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
In addition, Modern Medical provides:
P Pre-appointment confirmation with Claimant P Confirm appointment with transportation providerP Facility arrival confirmation P Weekly notes
800-547-3330www.modernmedical.com
We work harder to make your job easier, more efficient and cost-effective.
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
In addition, Modern Medical provides:
P Monitoring of Claimant’s progress P Weekly notes P Handling special requests
800-547-3330www.modernmedical.com
We work harder to make your job easier, more efficient and cost-effective.
Home Health Care
800-547-3330www.modernmedical.com
We work harder to make your job easier, more efficient and cost-effective.
8:45 am Monday - I’m able to get on with my day and know that my claimant is in trusted hands.
