Timeframes
What is the amount of time that the claim manage can extend to the claimant so that all records can be retrieved ?
15 days
Emails EXL India
June
What is the letter template used for termination of benefits on the basis of medical merit ?
1700
What is ending/stopping the claimants benefits (due to failure to produce medical records or on the basis of medical merit) ?
Termination
Give one reason(s) for referral to Nurse Consultation
1)Determination of diagnosis and confirmation that claimant continues to meet definition of disability, 2)multiple office visit notes with vague diagnosis, or 3) claim is 180 or more days since closed
What is the follow up date for 2nd request on all SHU claims?
30 days
Who is the Metlife Claims Specialist ?
The associate that contacts the claimant prior to termination of benefits
What is the acronym for activity financial inquiry ?
AFI
What is the date of close for disability ?
Maximum duration date
What is the EXL frequency for checking SIR to determine if information has been received ?
Every Day !
What is allotted time to submit an appeal ?
180 days
Who is the SHU 2 team ?
They receive referral if disability not determined (for reassessment )
What is the Special Handling Unit?
SHU
What is the annual SHU task ?
SHU medical verification (and sometimes summarization )
What is the protocol for when their is a mismatch in claimans daily activites/daily routine with the diagnosis?
SHU Nurse Consultation
What is the date of the first follow up for DIS 97?
60 days
Who contacts the case manager for authorization ?
EXL associate
What is the letter template used for termination of benefits due to a failure to produce medical information ?
4021
What is the Health Information Portability and Accountability Act?
HIPAA
Where are all activities and actions on the claim housed ?
What is day 12 (75%) and day 17 (90%) ?
Medical retrieval due dates ( and percentages ) for EXL
Who is involved in the CDM?
The Nurse, Medical Director and Unit Manager
What is significant about the states of California, Illinois, Maryland, Nebraska, New Hampshire, West Virginia?
These are the states that require specific wording for fully insured claims in the SHU determination letter.
What is long-tem disability claim with no possibility of return to work ?
SHU Claim
What is the letter template for termination of benefits due to failure to produce medical information ?
4021