Timeframes
15 days
What is the amount of time that the claim manager can extend to the claimant so that all records can be retrieved?
Emails EXL India
June
1700
What is the letter template used for termination of benefits on the basis of medical merit?
Termination
What is ending/stopping the claimant's benefits (due to failure to produce medical records and or on the basis of medical merit)?
Reasons to refer a claim to a nurse consultant
What are: need determination of diagnosis and confirmation that cx continues to meet definition of disability, multiple office visit notes with vague diagnosis, and claim is 180 or more days since closed?
30 days
What is the follow-up date for 2nd request on all SHU claims?
Contacts the claimant prior to termination of benefits
Who is the MetLife Claim Specialist?
AFI
What is the acronym for activity financial inquiry?
Maximum Duration Date
What is the date of close for disability?
EXL Frequency for checking SIR to determine if information as been received
What is daily?
180 days
What is allotted time to submit an appeal?
Receives a referral if disability is not determined
Who is the SHU 2 Team?
SHU
What is Special Handling Unit?
SHU medical verification
What is the annual SHU task?
Mismatch in claimant's daily activities daily routine with the diagnosis
What is one of the reasons that a referral would be to the SHU Nurse Consultant?
60 days
What is the date of the first follow-up for DIS '95?
Makes a determination on the basis of medical merit
What is the SHU 2/Reassessment Team?
4021
What is the letter template used for termination of benefits due to a failure to produce medical information?
HIPAA
What is the Health Information Portability and Accountability Act?
Diary of the claim
Where are all activities and actions housed?
Medical retrieval due dates for EXL
What is day 12 (75%) and day 17 (90%)?
Claims Determination Meeting
Who are the Nurse, Medical Director, and Unit Manager?
States that require specific wording for fully insured claims in the SHU determination letter
What are the states of California, Illinois, Maryland, Nebraska, New Hampshire, West Virginia?
SHU Claim
What is a long-term disability claim with no possibility of return to work?
4021
What is the letter template for termination of benefits due to failure to produce medical information?