WorkSafe has in place an Auditing Framework of incentives (and other item codes) paid to Occupational Rehabilitation (OR Occupational Rehabilitation) providers.
The framework exists to maintain high levels of data integrity in the oversight of performance of OR providers and to accurately reflect outcomes achieved by OR providers.
There are two key audit streams:
New Employer Services Incentive (OES) Audits
Both audits identify incentives that may have not met the billing practices as outlined in the OR Fee Schedule
OES and NES incentives audit process
The following process applies with respect to OES and NES New Employer Services incentive audits:
|Receive incentive exceptions||
Within the first 5 business days of each month, WorkSafe provides each Agent OR SME incentive exceptions for their review
The Agent OR SME must review the data from WorkSafe within 4 weeks paying particular attention to the “reason” as identified in the reporting for the incentive being flagged
Note: the Agent OR SME review should include Novus / ACCtion claim and payment records
|Return review comments||Agents should return the data from WorkSafe with commentary by the end of the 4 week period|
WorkSafe reconciles line items where an incentive is not payable.
Incentive is not payable
WorkSafe writes to OR provider to confirm that the incentive:
WorkSafe to nullify incentive from OR performance data
Following confirmation from all parties that the incentive/s are not payable; WorkSafe will request the incentive/s are nullified from data