Service and staff workload
See what your staff will actually need to do.
Confirm which of your response types the provider supports and what work the service includes. Fire response cost recovery, patient transport, and medical billing involve different work. Ask to see the process for the incidents your department wants to submit.
Questions to bring
- Can you show a complete submission, including parties, insurance information, and attachments?
- What will our staff need to enter, and which records should they have ready?
- Who prepares the bill, answers insurer questions, and follows up?
- What happens when documentation or insurance information is missing?
The billing policy
Know who receives the bill.
Read the billing policy with a denied claim in mind. Your department needs a clear answer about what happens when an insurer will not pay, as well as who receives the original bill.
Questions to bring
- What happens when there is no applicable insurance?
- What happens after an insurer denies a claim?
- Can a bill ever be sent to a resident, nonresident, patient, or another individual?
- Can we review that policy in writing before we start?
Fees and department payments
Follow the money to your department.
| Ask the provider | Why the answer matters |
|---|---|
| What triggers your fee, and when is it deducted? | Know whether the fee depends on recovered funds and whether any other charges apply. |
| Who receives the insurer’s payment? | Understand where the money goes and how your department receives its share. |
| How will we confirm a department payment was issued? | A calculated department share and an issued payment are different. Ask how you can verify each. |
| How are receipts, fees, and the department share shown? | Your finance team needs to be able to follow the amounts through the payment breakdown. |
| Whose rate schedule do you use? | Ask how rates are set and updated. A rate schedule does not establish insurance coverage. |
| What happens to open claims if we stop? | Clarify who handles follow-up, records, and outstanding payments. |
Reporting and customer results
Ask to see the report behind the number.
Work through a sample report together. Check what period it covers and whether each figure means an amount billed, a recorded insurer payment, or a calculated department share.
Give customer results the same attention. Check the incident type, number of responses, reporting period when available, and what the published amount represents. One department’s result does not tell you what yours will recover.
- Amount billed
- The amount requested from the insurer.
- Insurer receipts
- Payments received from the insurance company.
- Department share
- The amount allocated to the department after the provider’s fee.
- Department payment
- Money issued to the department. Confirm this separately from a calculated share.
Questions to bring
- Where will we see submitted, denied, and open claims?
- Can you explain the billed amounts, payments, fees, and department share in this report?
- Who can access reports, and which reports can we export?
- Will reports be sent to us, or will our staff retrieve them?
A review your whole team can use
Let the people doing the work review the process.
Include the person who submits incidents, the person responsible for local approvals, and the person who reviews department payments. Let each bring questions from their own work.
If you use a pilot, agree on what you want to learn and how open claims will be handled afterward. The end of a trial is not a deadline for insurers to make payment decisions.