Benefit Eligibility / Claims Administration
This evaluation is one tool to help determine whether an individual qualifies for coverage or benefits under a specific insurance policy.
What is a benefit eligibility assessment?
This tool may be utilized when a claimant reports needing assistance with all activities of daily living but neighbors report them independently shopping and driving.
What is surveillance?
This tool is being piloted for LTC claims to quickly summarize medical records and claim requirements, aiming to improve decision quality and reduce processing time.
What is AI-driven document summarization?
These records document observations, services provided, and client progress during each interaction, and are essential for continuity of care and claims validation.
What are daily visit notes?
These care provider’s notes are identical across multiple dates, with no variation in patient condition or services rendered.
What is cloned documentation?
This technology allows for more accurate projections of future long-term care costs, which aids in setting appropriate premiums, ensuring adequate reserves, and improving valuations.
What is predictive analysis?
This approach involves identifying potential issues before they escalate and implementing solutions to improve customer satisfaction and reduce formal grievances.
What is proactive complaint management?
These individuals provide care without proper credentials.
What are unlicensed caregivers?
This emerging tool leverages automation and business rules to process straightforward claim payments instantly, freeing examiners to focus on complex cases.
What is auto-adjudication?