Policies
Where can you find the situs state for the Policy?
What is the Face Page
What are two traits that a CM should possess that a customer would want?
What is the correct order of the following: Review Policy, Review Information, Triage
Review Policy, Triage, Review Info
Provides policy, process and technical expertise and coach Case Managers
Who is Technical Lead/Coach
What is the next step after you review the policy of a new claim in the high level LTD workflow?
What is triage
Under what provision would I find when insurance terminates?
What is the Termination of Disability Benefits
What is one way we can meet ER expectations?
What is Cost-effective claim administration, simple process, reduced administrative burden and accuracy.
What are the 3 policy provisions for eligibility?
What is classes of eligible employees, eligibility waiting period and effective date of insurance
What group can contact the treating provider to clarify diagnosis and treatment to provide a clear clinical picture?
What is Clinical Resources
Name one reason an LTD claim would close?
Max benefit period is reached, not eligible, we determine they are no longer disabled per the policy, RTW FT FD, no longer receiving appropriate care, customer passes away
Where can I find the amount of benefits for each class under the Policy?
What is the Schedule of Benefits
Name from whom we can receive an LTD claim?
Who is customer, Employer or third-party
What is the amount of time the employee must be a member of one of the policy’s Classes of Eligible Employees before becoming eligible for insurance called?
What is Eligibility Waiting Period (EWP)
Who partners with Vocational and Medical resources to execute an appropriate claim strategy.
Who is the Claim Manager
Name one item the claim strategy should include?
Policy provisions that apply to decision, actions documented in real time, a summary of relevant facts to your decision, decision rationale, key claim decisions, timeframe decision covers, estimated resolution and next steps
What does EDOC stand for?
What is Effective Date of Coverage
What is DOH, LDW, First Day Missed, Payroll, Active Status, eligibility clarification
What kind of policy is it when premiums are paid in all or in part by the Employee?
What is contributory
Who loads the claim details into AdminSuite?
Who is Intake
Who receives the claim first and inputs the initial information into the claims system?
Who is Intake
What is the most common Pre-Existing Condition limitation provision?
What is 3/12
If the plan is non-contributory, who is responsible for premiums?
Who is Employer
If you are considered a late entrant, what would you need to provide to establish coverage?
Evidence of Insurability (EOI)
Who is responsible for translating a job description into material duties of the Regular Occupation?
Who is Vocational Resources
As a claims manager, once I review the policy and triage the claim, what is my next step?
What is gather information