Notice and Proof
What do you do on a Day 7 Task?
Contact the AP for an update on request and contact ee for update and to inform them of what AP said
You are reading medical- the claim needs a medical review; you had to update the dx code- do you set a task for the next day to send through Chorus or send today?
Next day the DX code will batch overnight
Who is the customer who you must manually set up a leave, send an email w/ADA form, and process as an AS event?
GoDaddy
Do we use claims pad for the II note when deferring or denying the claim?
Yes- every claim needs and ii note
Where do you find the class type for the claim?
Eligibility File
When do you start initial notice and proof?
After the first II attempt if not able to approve or reach ee
Can you preapprove an stdcp claim?
yes but you can not close until DOD
What customer do we have to verify PTO usage for supplementing for benefits?
Main Line Health
What is newly required in all initial approval notes from the claims PAD?
MDA min/opt/max durations
If the Sub/Loc Change during the claim- does this effect the benefits assigned?
Yes, likely will need to be reassigned or recreate claim.
Yes it can be sent to both parties.
If the claim is approved through the max benefit date- do you need to set a task to close claim end date?
No, this should be closed if the dod is present or in the past.
When did Turnpoint's Bonding benefits begin?
1/1/25
If you cannot reach the ee, but you did cx sx with the ap office would you go forth with approving the claim?
If all the information is confirmed yes.
If the ee was in the hospital for surgery but not admitted what should the disability type be?
Sickness
If we can not confirm whether the ee has been released to return to work or need more information from LOV- would we attempt to reach out again or start notice and proof?
Start notice and proof
Should you be setting tasks on closed claims? GENERIC QUESTION DO NOT OVERTHINK!
No- there are of course one offs (RR INT BONDING) but this could be viewed as work avoidance.
Do we create an Own Personal Leave for Main Line Health for bonding when FMLA not elig or exhausted?
NOOOOOOO!
Who do we contact if by 2:00pm we cannot finish our II's for any given reason?
The team group chat, it is your own responsibility to have all of them completed.
If the disability type comes through intake as WC- but the ee confirms it is not WC what does the case manager do?
Change to reflect no WC
Medical comes in on day 45/15- we cannot render a decision without review. What is the Case Managers next steps?
Send the Claim through CHORUS- complete the review request send the ERISA extension letter to ee and communicate with ee.
You are nearing the end of your day and there are tasks on your desk you did not get to today- Would it be okay to move them to the next day?
NO this is again what could look like word avoidance- it is okay to have work beyond day 0 or 1, if greater than three days reach out to Missy and Morgan for desk management assistance
MLH, Six Continents, Global Payments and Global Foundries
Do you need an additional approval note, if you can approve based on the II phone note?
No that one note can serve as the approval note as well.
When establishing a disability type for an MA PFL bonding after maternity- What should the disability type be?
Hospital Sickness