PFML Jeopardy - Claim Intake

Updates Priorto Intake

100

What field(s) are updated in the "Languages" section on the party record prior to starting a claim in FINEOS?

What is "Preferred Language"

200

TRUE or FALSE:

If the customer does not provide a MA ID or out of state ID number, you cannot proceed with intaking the claim.

False.  If the claimant does not have a MA ID or out of state ID number to provide, the field may be left blank.

300

A claimant states they want to receive their payments through "Direct Deposit".  When you navigate to the payment preferences tab, you see "Check" already listed.  In what scenario can you add the new payment preference without following the payment preference change process?

If "Check" is listed and the claimant has no prior claims, you can add "Direct Deposit (EFT)" without following KB0010197 to change the payment preference.

400

TRUE or FALSE: 

If the claimant receives mail at a different address than where they live, only the mailing address is required on the party record.

False.  You must include the home address where the claimant lives and also add an Alternate Mailing address where they receive their mail.

500

Per your KB, what should be updated in the "Communication Preferences" section on the claimant's party record?

Nothing!  This section should not be edited during intake.

Employers &Occupations

100

TRUE or FALSE:

It's possible to see more than one employer listed under a claimant's party record.

True.  Make sure you are editing the job title and occupation details for the correct employer.

200

What should you do if you see a job title of "DEFAULT" on the party record?

Update the job title to be their current job title for that employer.

300

What additional field needs to be filled out in the Occupation record in FINEOS if the claimant works for the COMM OF MASS COMPTROLLER’S OFFICE employer organization?

Organization Unit

400

What error did the agent make in the following screenshot?

The Employment Status should always show as "Active", even for unemployed claimants.

500

TRUE or FALSE:

If a claimant has not yet told their employer of their intent to take leave, you cannot proceed with claim intake.

False.  We will not refuse intake if the claimant has not notified their employer.  However, the employer can choose to have the the claim denied for not being provided 30 days notice.

Leave Schedules& Work Patterns

100

The claimant indicated to you that their work schedule changes every other week. The first week, they work 10 hours per day Sunday through Wednesday. The second week, they work 10 hours per day Tuesday through Friday. Then, the schedule repeats. Is this accurately captured in this screenshot?

Yes, this is accurate.  This reflects a 2-week rotating schedule.

200

This claimant reported that they work 40 hours per week - 8 hours per day, Monday through Friday. Is this work pattern captured accurately?

No, the agent entered 8 minutes per day instead of 8 hours per day.

300

You have already updated the claimant's occupation record to state they work 35 hours per week.  When you arrive at the work pattern screen, the claimant provides the work pattern on the following image.  Does this make sense?

Yes.  7 X 5 = 35 Hours.  

400

What step has the agent forgotten based on the image in this screenshot?

Clicking "Apply to Calendar" to ensure the changed work pattern is applied to the leave dates below.

500

During claim intake, a claimant states that their work schedule changes every single week and is rarely the same.  However, they always work 42 hours per week on average.  What should be entered in the "Work Pattern Type" field in this instance?

Fixed. Although this is reflecting of variable work schedule, we enter "fixed" then the 42 hours per week would be divided out over the 7 day period equally. 

AdditionalDetails

100

TRUE or FALSE:

If you are filling out the "Additional Absence Details" screen for a Medical Leave claim and selected "Yes" in Hospitalization details, you will see open fields appear for hospitalization date and discharge.

True.  

200

True or False: You may enter estimated dates or leave blank the hospitalization and discharge dates fields if the claimant is hospitalization dates are unknown.

True. Enter the estimated date(s) if specific dates are not yet known or leave blank as these fields are not mandatory. (KB0010871)

300

TRUE or FALSE:

If a claimant wants to have taxes withheld, this is the correct way to capture in the Additional Absence Details screen:

False.  Both checkboxes should be checked if the claimant would like to have taxes withheld.

400

True or False: If the claimant does not want taxes withheld, only one checkbox (SIT/FIT Opt In has been verified) should be checked

True

500

When done filling out the Additional Absence Details Taxability section, what should you do? 

Click "Next".

Claim Wrap-up & Next Steps

100

After you have completed claim intake, which KB should you reference if you see a status of "Employment Confirmation" instead of a status of "Adjudication"?

KB0010771 - Employment Confirmation Status Fix Job Aid

200

After successfully completing claim intake for a medical leave claim, what supporting documentation would you instruct the claimant that they need to provide for identification purposes?

Proof of ID of the Claimant – Mail hard copy.  (Fax is not an option as this must be received in color)

300

What KB would you use to find out what supporting documents are required for Medical Leave?

KB0010132 - Supporting Documents

400

What KB should be referenced if after successfully submitting a claim you see that the Applicability in the adjudication table shows as "Undetermined"?

KB0010772 - Applicability Status Undetermined or NA Fix - Job Aid

500

TRUE or FALSE:

Channel-switching options should always be discussed with each claimant during the wrap-up step of claim intake.

True