Key Players
Registered Nurses with extensive backgrounds in long term care practice.
Who are Care Coordinators?
We want to advise the enrollee that it can take up to this many weeks for a decision to be made on benefit eligiblity.
What is 8-10 weeks?
The brochure the enrollee will receive once they have been determined benefit eligible.
What is the Using Your FLTCIP Benefits Brochure?
The ticket you will submit in AWD when you need to reissue a check.
What is a Claim Call-In ticket?
The portal you can use to check on the status of ordered medical records.
What is Parameds?
The group that assists claimants with all aspects of the claimants policy.
Who are Transition CC's?
What is up to 30 minutes?
The first step the enrollee should take once they have been approved to start a claim.
What is establish an approved plan of care?
We are unable to reimburse for expenses if the provider is not included on this.
What is Plan of Care?
The website you will use to locate providers within a given area.
What is the LTCG Portal?
Once the insured fully understands their policy, they are moved to this group.
Who are Maintenance CC's?
Communicating policy & coverage information is this step within the BE Intake Process.
What is Step 3: Communicate Policy & Coverage Infomation?
Hospice agencies, visiting nurse associations & home health agencies are an example of this type of care.
What is a formal caregiver?
The form the facility or agency must complete that includes their Federal Employee Identification Number (Tax ID).
What is a W9 Form?
What is My LTCFEDS?
Who are Provider Specialists?
It's necessary the enrollee complete these forms in order for us to move forward with the claims process.
What is the Medical Release Form; W9 Form & Claim Initiation Form?
The benefit where a Care Coordinator may approve alternative services to the plan of care that are deemed appropriate and cost effective.
What is Alternate Plan of Care?
Once the enrollee has been determined benefit eligible and has satisfied the waiting period, the claim status in CARE will reflect as this.
What is benefit period?
The ticket in AWD you will submit when the claimant is requesting a history of their paid claims.
What is a Claims Payout Report?
The group responsible for processing invoices.
Who are Claims Processors?
Assisting the unauthorized caller as much as possible without violating HIPAA is this step within the BE Intake process.
What is Step 1: Gather Background Information?
Providers must meet qualifications outlined in this resource in order to be certified and included in an approved plan of care.
What is the Benefit Booklet?
The ticket in AWD you will submit when there has been an update to the AOB.
What is Provider Specialist Call-In ticket?
If an unauthorized 3rd party is requesting a claim payout/MLB report, you should take this action instead.
What is submit a Compliance Inquiry ticket in AWD?