Time Service
It is the turn around time for new apps.
What is 4 business days?
This is expected to be uploaded to Content Navigator upon the initial work up (BCS has discretion on maternity and pay and close claims).
What is the policy booklet?
If the claimant had prior coverage and the prior plan is the lesser plan, this is the next step/review.
What is complete a pre-existing review on the MOO Policy?
This should be put in a pended status upon approval of the claim, to ensure special handling notes are updated.
What is the action plan?
These are the claim notes that should be entered upon working up your claim.
What is eligibility note, synopsis, and claim direction note?
This is the expected frequency of phone calls on pending claims.
What is weekly for STD and bi-weekly for LTD?
If the BID is greater than this many days, the claim should be placed into future status.
What is 15 days?
This is the duration for which FICA should be withheld.
What is 6 months from when total disability began?
It is the turn around time for emails and return calls.
What is half-day?
These are methods in which we can verify prior coverage for an employee.
What is PC bill, PH Statement, email from PH, or prior carrier enrollment form?
If the BID is greater than this number of months, the claim should be set to future status.
What is 3 months?
The claim requires sign off from your TL, and the claim to be put into conditional status when paying under this.
What is ROR (Reservation of Rights)?
This step should be taken before referring a claim for CNC review.
What is bringing a claim to RT or obtaining TL sign off?
This is the turn around time for Team Leader sign offs.
What is 2 business days?
This is required to be completed when an employee enrolls late or outside of the initial enrollment period or an open enrollment period.
What is EOI?
This is the duration for which no earnings loss results in the claim potentially being closed.
What is 3 weeks or STD or 3 months for LTD?
This is the turn around time for action taken on RT, CNC, IME, IPA, etc. (including drafting the decision letter).
What is 2 business days for STD and 4 business days for LTD?
This is where you identify if an ASO group has elected for EFT to be allowed on their claims.
What is the provisions report?
The acknowledgement letter should be manually sent in these situations (give 1 example).
What is, when a policy comparison determines a pre-ex review is no longer required, when there is attorney representation, if information that is not standardly requested is needed for the claim?
What is approving CID (Sending any occ ok letter), phone call to claimant, SSDI POF on file if SSDI is pending, all overpayment recoveries set up, management sign off, task template to be completed, Action plan to be updated, benefit period set out to the max or 1 year out?
This should be reviewed anytime the claimant resides or works in a state that may have state benefits.
What is Disability State Specific Regulations?