Steps to Audit a "Hines File" PDF

Steps to Audit a "Hines File" 1 The purpose of auditing a file is to align with the VFP of the post. It is aimed at managing all personal injury clients efficiently from their assigned case manager and ensuring that all necessary data is present for a file to be considered complete. These steps are...

Steps to Audit a "Hines File" 1 The purpose of auditing a file is to align with the VFP of the post. It is aimed at managing all personal injury clients efficiently from their assigned case manager and ensuring that all necessary data is present for a file to be considered complete. These steps are designed to maximize your efficiency and ensure that no data is missing. 2 Navigate to https://docs.google.com/spreadsheets/d/1sYfRIEsILMwNCO_OtmFx H_zGE1R3qsgM59CKLwYt2yw/edit#gid=302333413 3 "LLC" (Limits, Liability, and Case Specials) constitutes the primary emphasis of this post. In the in-treatment Google Sheet, ensure that these three crucial data sources are completed. Please note that the Case Special data will require ongoing updates until the client has concluded treatment. Made with Scribe - https://scribehow.com 1 4 "LLC" (Limits, Liability, and Case Specials) constitutes the primary emphasis of this post. In the in-treatment Google Sheet, ensure that these three crucial data sources are completed. Please note that the Case Special data will require ongoing updates until the client has concluded treatment. 5 "LLC" (Limits, Liability, and Case Specials) constitutes the primary emphasis of this post. In the in-treatment Google Sheet, ensure that these three crucial data sources are completed. Please note that the Case Special data will require ongoing updates until the client has concluded treatment. Made with Scribe - https://scribehow.com 2 6 Once you have identified any missing data or information requiring confirmation, copy "MAT-NUMBER". 7 Switch to tab "Litify | Salesforce" 8 Click "Search..." Made with Scribe - https://scribehow.com 3 9 Right-click on the "Search..." field and paste the Matter number from the "In Treatment" Google Sheet. 10 Made with Scribe - https://scribehow.com 4 11 Upon accessing the Matter, the first task is to confirm or update any Liability or Uninsured/Underinsured Motorist (UM) information. 12 In this example, "Bristol West Insurance Group" serves as our Liability Carrier. It's imperative to ensure that the following information is completed: Adjuster name, contact information (phone number, fax, and email), policy holder details, policy number, available limits, acknowledgment of liability by the carrier, and receipt of the declaration page and letter of representation (LOR). Made with Scribe - https://scribehow.com 5 13 In this example, you may observe that some contact fields are currently incomplete. It's crucial that these fields are filled out promptly. Failure to do so will result in the Director of Personal Injury receiving daily notifications regarding the "missing data." These notifications will persist until the necessary fields are properly entered. Made with Scribe - https://scribehow.com 6 14 To modify any field in this section, click on the edit button (pencil icon). 15 Please bear in mind that certain data may already exist in the file but might not be in the correct data field. For instance, information such as adjuster name, phone numbers, or email addresses might be found in the "Comments" section. Made with Scribe - https://scribehow.com 7 16 If adjuster information needs to be added, please begin by entering their name under the "Adjuster" field. It's important to note that most adjusters are already saved in our system.. 17 If you're unable to find the adjuster by first name, please try searching by last name. If nothing is found, you'll need to create a "New Party." However, remember to add a "New Party" only if we don't have adjuster information in the system. Made with Scribe - https://scribehow.com 8 18 When creating a New Party, ensure that the "Litify Individual A Person" option is selected, then click "Next." 19 Once in "New Party" continue to filled in the necessary data. Made with Scribe - https://scribehow.com 9 20 Click "Adjuster" 21 Click "Mr." Made with Scribe - https://scribehow.com 10 22 Click "English" 23 Once all data is entered, Click "Save" Made with Scribe - https://scribehow.com 11 24 Upon creating a new party, you will now have the capability to locate the adjuster in the designated adjuster section by entering their name. Once the adjuster's name is inputted, proceed to populate all requisite data fields accordingly. 25 Click here. Made with Scribe - https://scribehow.com 12 26 After inputting and saving all pertinent data, repeat the same steps to input UM (Uninsured Motorist) Insurance information. In this instance, you may observe that the checkboxes for "Dec Page Received" and "LOR Received" are unchecked. These will be addressed in the next steps in training. Made with Scribe - https://scribehow.com 13 27 Now, we will proceed to confirm whether any Letter of Representation (LOR) or Declaration page is absent. These documents can be located in the document section of Litify. 28 The quickest way to view all documents in the Matter is to click on "List." Made with Scribe - https://scribehow.com 14 29 By clicking on the file, a preview window will appear. Confirm that the amounts previously saved in the liability insurance tab match to ensure data accuracy. 30 In this example, we can confirm that LOR to liability is also saved. Made with Scribe - https://scribehow.com 15 31 Clicking on the number of documents displayed per page will enable you to view more files without navigating away from the current browser window. 32 In the next two steps, we have confirmed that we received both the UM declaration page and rejection letter. Rejection letters are crucial to include in the file, as they verify that our client has no additional coverage other than the liability carrier. It's important to examine the signature on the rejection to ensure it matches our client's signature. If you notice any discrepancies, please notify the Case Manager immediately. Made with Scribe - https://scribehow.com 16 33 Click "UM rejection from - travelers.pdf" 34 Now that we have confirmed that the Declaration pages and LORs have been sent, we need to ensure that we check off the completed box in the insurance tab. Made with Scribe - https://scribehow.com 17 35 In this example we will Click "Bristol West Insurance Group - Robert Voktasek."" The liability carrier 36 Once in the liability carrier section, click "Edit Claim Number" Made with Scribe - https://scribehow.com 18 37 Click the "Dec Page Received" field. 38 Click the "LOR Received" field. Made with Scribe - https://scribehow.com 19 39 Click "Save" 40 After completing the liability carrier section, repeat the same steps as outlined above. Made with Scribe - https://scribehow.com 20 41 Click "Edit LOR Received" 42 Click the "LOR Received" field. Made with Scribe - https://scribehow.com 21 43 Click the "Dec Page Received" field. 44 In this example we will click the "Comments" field as we want to update that we have confirmed that we have a "rejections of UM letter" saved in the Matter. Made with Scribe - https://scribehow.com 22 45 Type "UM/UIM REJECTED" 46 Click "Save" Made with Scribe - https://scribehow.com 23 47 It's important to maintain an organized file at all stages of the Matter. Always ensure that all documents are labeled with something that can be quickly identified. For instance, a file named "23njsf.jpg" may come from a client. If that's the case, you'll need to relabel it to describe its content in detail. For example, "Property Damage of Front Bumper". The following steps will outline how to organize a file. 48 To rename a file, click on the file that needs to be edited. Made with Scribe - https://scribehow.com 24 49 Click "Info" 50 Click "Edit" Made with Scribe - https://scribehow.com 25 51 Click this text field. 52 Re name the document to the proper title. In this example, "UM DECLARATION PAGE" Made with Scribe - https://scribehow.com 26 53 Click "Save" Organization of Documents Made with Scribe - https://scribehow.com 27 54 While in the Documents section, ensure that all documents are placed in their assigned folder. No files should be left outside of their designated folder. In this example, we have identified some insurance documents that need to be moved into the insurance folder. You can select the checkbox next to each file to highlight one or multiple documents. For this example, we will highlight more than one document. 55 Made with Scribe - https://scribehow.com 28 56 Click here. 57 Click here. Made with Scribe - https://scribehow.com 29 58 By clicking on the icon highlighted a menu option will open. 59 Click "Move Files" Made with Scribe - https://scribehow.com 30 60 In this example we will select "Insurance Docs". 61 Click "Move Files" Made with Scribe - https://scribehow.com 31 62 From time to time, you may come across saved documents that serve no purpose. These typically originate from images saved from emails. Such files can be safely deleted from the Matter. These files often have extensions ending in ".png". 63 Always make sure to preview any file before deleting. In this example we can see that what will delete is a logo. Made with Scribe - https://scribehow.com 32 64 You can also delete multiple documents at once by highlighting the box next to the file. 65 Once you have confirmed which files are safe to delete, click on the highlighted icon to open a menu option. Made with Scribe - https://scribehow.com 33 66 Click "Delete Files" 67 Click "Delete 20 Files" Made with Scribe - https://scribehow.com 34 Validating Treatment Completion and Balances with Medical Providers 68 Once we have ensured that our Matter is organized and verified with workable limits and liability acceptance, we can begin to verify providers. Starting with organization and insurance verification is crucial because during confirmations of balances and treatment with medical providers, they may inquire about policy limits and liability. Conversations tend to proceed more efficiently when you have the necessary data at hand. We will initiate this process by reviewing the previous "in treatment" notes in the Matter. Made with Scribe - https://scribehow.com 35 69 Click "TREATMENT" Some cases may not yet have a treatment note topic if they are newly opened. In such cases, check the "Treatment" tab to identify which provider the client is currently seeing. Each file should have at least one doctor the client is consulting. If you don't find any in the "Treatment" tab, coordinate with the Case Manager to obtain this information. 70 In this example, we have a provider listed in the treatment tab. To access any contacts within that facility, we need to click on it to expand the information, allowing us to reach out to specific individuals or departments. It's advisable to always call, as this helps you become familiar with the provider. Building connections with providers makes future interactions easier. Made with Scribe - https://scribehow.com 36 71 Click "Dominguez Chiropractic" 72 In this example, this provider only offers an email contact. You can easily copy and paste the email into your Outlook and request the necessary information. Made with Scribe - https://scribehow.com 37 73 Click the To Recipients text field If this is your first time reaching out to a provider, an email with the following language can open the door for you to engage and expand your network. I hope this message finds you well. I am writing to inquire about the current status of treatment for our client mentioned above. Could you kindly inform me if the client has completed their treatment? Additionally, I would like to know if any MRI scans have been conducted or if any referrals have been made. Furthermore, could you please confirm the current running balance for the client's account? In the future, I would like to know who would be the best person to contact regarding obtaining the information mentioned above. If possible, could you provide me with a direct email address or phone number? Thank you for your assistance and cooperation. As mentioned in steps above, a phone call is always preferred when trying to get update/balance Information from a provider. During that phone call, if you become aware of a referral, it's always good to ask if they have a direct contact for that referral so you can reach out to them. Made with Scribe - https://scribehow.com 38 74 Ensuring all emails are archived within the matter is crucial. To achieve this, simply access your sent folder, locate the relevant email, and from the top menu bar, click on 'More Items'. 75 Click "Litify Inbox" Made with Scribe - https://scribehow.com 39 76 Type the Matter Number and press 'Enter' text field 77 You can also Click "Paste" if you have copied the Matter number. Made with Scribe - https://scribehow.com 40 78 In this example we will click "MAT-24031336123 · Norbey D Avila Hurtado | 3/2024 | Automobile Accident Norbey D Avila Hurtado " and save. 79 Receiving data without taking action can pose risks. It's essential to communicate any updates promptly to the Case Manager, whether it's regarding updated balances, new referrals, completion of client treatment, or any concerns expressed by providers Made with Scribe - https://scribehow.com 41 Tip! If a provider mentions that a client has completed treatment, it's crucial to notify both the medical records team and the Case Manager. This step is vital to ensure that our medical records team can promptly initiate the process of requesting bills and records. Depending on the provider, this process can be time-consuming. By informing our medical department as soon as the client completes treatment, we can expedite the sending of demands 80 Next we need to document the file of all treatment updates. We will need to update the "In treatment" note topic in Notes. Made with Scribe - https://scribehow.com 42 81 Keep in mind that if the file is new, there won't be one. You can always create one by clicking 'New' in the Notes section 82 If there is already a note topic titled 'TREATMENT,' please refrain from creating a new one. Instead, update the existing note. Made with Scribe - https://scribehow.com 43 83 Click "Edit Note" 84 Add your notes to the top of the previous notes, ensuring to include the date of the new entry and your initials. Made with Scribe - https://scribehow.com 44 85 Click here. 86 Enter new in treatment update Made with Scribe - https://scribehow.com 45 87 Click "Save" 88 Occasionally, you may encounter a missing provider in the "Treatment" tab or become aware of one while contacting a provider. The following steps detail how to add a new provider. It's advisable to add a provider even if there's uncertainty about their relation to the accident. This ensures thoroughness and aids our medical records team in requesting all relevant bills and records. Made with Scribe - https://scribehow.com 46 89 Click "Treatments (Matter) (1)" 90 Click "New" Made with Scribe - https://scribehow.com 47 91 Type "Ortho" 92 In this example we will chose "Ortho Sport And Spine". If the provider is not on the list you will need to add a "New Party". This will need to be entered as "Litify Business or other entity" Made with Scribe - https://scribehow.com 48 93 Click the "Treatment Date" field. 94 Chose the date client started treatment with provider. Made with Scribe - https://scribehow.com 49 95 Click "--None--" 96 Click on the type of service the provider is giving client. Made with Scribe - https://scribehow.com 50 97 Click on the applicable status. 98 Click the "*Injury" field. Made with Scribe - https://scribehow.com 51 99 100 Click on the injury that the provider is providing care for. If this is a new "injury" make sure the Case Manager is aware. Most treatment is done by "lien". In the event that you are aware the treatment is being giving under another options, Notify CM immediately. Made with Scribe - https://scribehow.com 52 101 Click "Save" Verifying Completion of Details 102 A complete Matter will contain all the necessary data to proceed to the next stage of the case. Our responsibility is to ensure that no missing data causes a delay or a DEV-T for another staff member. A fully populated Party Details and Details Tab ensures that the next staff member handling the file can complete their task seamlessly, without needing to pause to gather information that should already be present. Made with Scribe - https://scribehow.com 53 103 Party Details should have all fields compleated. 104 If any data is missing, you can click "edit" and input the missing data field. If something is missing, notify the Case Manager immediately. In most cases, they will have direct knowledge of the missing data and can update the Matter without needing to contact the client. Made with Scribe - https://scribehow.com 54 105 Next, we will insure that all data fields are completed in Details. If something is missing, notify the Case Manager immediately. In most cases, they will have direct knowledge of the missing data and can update the Matter without needing to contact the client. 106 Click "Details" There should be no empty data fields in Details tab. Most of the data fields can be filled without necessarily calling the client. Information can be gathered from police reports, medical records, or notes. However, the following below fields are IMPERATIVE to have and can only be obtained directly from the client. If these are missing, immediately inform the Case Manager so they can update the data fields. Made with Scribe - https://scribehow.com 55 107 Current Status Should always be filled. During the treatment stage, please insure Treating is being selected. 108 Authorized person(s) to know about case. Made with Scribe - https://scribehow.com 56 109 Prievious Accident Details 110 Explain LPD process if applicable Made with Scribe - https://scribehow.com 57 111 Initial Medical Providers Alert! This step is crucial for our Medical Department. If a hospital visit is noted, a chatter must be sent to the Medical Department immediately so they can initiate the necessary processes promptly. Remember, obtaining hospital records can be time-consuming. Delaying this process can hold up the file completion. Ensure that a chatter was sent on both older and new files to Medical Department. 112 If not hospital Type "NO DOL -" Made with Scribe - https://scribehow.com 58 113 Health Insurance Name Alert! This step is crucial for our Health Insurance Department. If health insurance is noted, a message must be sent to the Health Insurance Department immediately so they can initiate the necessary processes promptly. Remember, some subrogation's can be time-consuming. Delaying this process can hold up the file completion at the time of settlement. Also, keep in mind that if client does have health insurance, we need a photos of the back and front of their card ASAP. Ensure that the chatter was sent on both older and newer files to our Health Insurance Department. 114 Type "NO HEALTH INSURANCE" if client does not have one. Made with Scribe - https://scribehow.com 59 115 Previous Injuries 116 Job Title Made with Scribe - https://scribehow.com 60 117 Job Duties 118 Ante Litem ( this can be found by looking at the police report) If this is needed, a massage to the assigned Insurance Assistant from the POD is notified via chatter. Updating In treatment Google Sheet Made with Scribe - https://scribehow.com 61 119 Always remember that "In Treatment" Google Sheet need to be updated as well. Our Google Sheets provide us with a snapshot of all Case Managers' files without the need to access each file individually in Litify. Any new data should always be noted. The primary responsibility of our Case Advocates is to ensure that the "LLC" data is completed, which includes: 1. Verifying Limits 2. Establishing Liability (either with the at-fault party or the client's UM) 3. Providing the current balance of medical bills. It is also imperative that the "Details Tab" is completed. In the following steps, we will outline how to make any updates or changes. 120 In this example the current total balance is pending verification. Made with Scribe - https://scribehow.com 62 121 We have noted that what when and what we done to request. Its important to date the action. 122 Next, we will indicate whether the details have been completed in Litify or if we have requested further data from the Case Manager. Made with Scribe - https://scribehow.com 63 123 Click here. Tip! While it's beneficial to communicate updates or information needed to the Case Manager via phone calls, Teams messages, or emails, sending a Chatter memorializes the data in the file, making it accessible to anyone who views it. The following steps will illustrate an example of the actions taken and what is needed from the Case Manager: Made with Scribe - https://scribehow.com 64 124 125 Click "Share" Made with Scribe - https://scribehow.com 65 126 Repeat these steps in all files. Made with Scribe - https://scribehow.com 66