II1
3 key verification questions for authentication
Full name
DOB
Address
What does high complexity diagnosis mean?
Means that the symptoms are hard to explain and might need to show documents to understand the complexity of the illness.
The acronyms VA and EA stand for
Voice and Electronic Authorization
How many weeks off do you get for pregnancy if it´s a C-Section?
8 Weeks
What does Low complexity diagnosis mean?
Means that the symptoms are easy to explain and might not even need to show documents to understand the complexity of the illness.
How many weeks off do you get for pregnancy if it´s a NVD?
6 weeks
Give 3 examples of Low Complexity illness/Injury
Fractures, Surgery and Pregnancy
Who determines the ID?
Claim Manager
Who provides this information during contact: Address, Phone & Fax, OVDates, Tx, Restrictions, Confirm Sx Dates?
Provider
This type of claim requires more investigation, and both the Tx and recuperation period are uncertain
High complexity
Examples of Information you obtain from EE contact (4)
Diagnosis
Job Duties
LDW /FDO
ERTW
R&L'S
Tx
VA / DA
Examples of Information you obtain from ER contact (4)
Date Of Hire
Elegibility
LDW
FDM /FDO
Schedule / Hours worked
Effective Day of Coverage EDOC
Salary
After giving birth, Barbie was Dx'd with PPD. It's pregnancy related, so her claim belongs to Low Risk. True or false.
False. PPD is considered a Mental Health Disorder.
What do we do if lawyer calls?
Verification process and send disclosure agreement.
What is required in order to be eligible to get STD benefits.
To have a disability.