Intake Flashcards
When is it ok to skip the Job Category question?
When EE is filing a claim for a reason other than OSHC. As the physical demands are not needed to determine if EE needs to be OOW for COFM or Bonding
When is it ok to skip the overnight Hx question?
Never, Overnight Hx question impacts EP. If EE has previously mentioned an overnight Hx then not asking isn’t skipping because you already have the information so you can just ask for the Hx name
Why is DOB needed on COFM claims?
Because it helps the APO identify the family member in order to complete the COFM MC
Why is it important to file a claim even if EE is not eligible for FMLA?
There may be other leaves types that apply. We were hired by ER to track ABS
What is the difference between COFM and Bonding claims?
COFM requires that family member has a medical condition causing them to need care. Bonding can be taken when there is the additional of a minor child to the family thru birth, adoption, or foster
What is the difference between Bonding: Adopted Child and Adoption Process: Adopted Child?
Bonding can only be taken once there is a child to bond with so this occurs once the child has been placed. Adoption Process are all the steps and EE takes to get the child placed with them. Examples: home visits, court dates, counseling etc
I say: “Unknown Start Date, Unknown Pattern…”
You say:
“Is only for Intermittent”
How do you add an ABS when EE is filing a claim for Continuous ABS but doesn’t have the dates for when the ABS will occur yet?
Add 2 wks of ABS 30 day in future
This is to force disability to pull on to the claim
If a pregnant EE reports she will be taking 12 wks total OOW for her maternity leave how much time will you add to the claim during intake?
About 6 wks. FDO will be start of ABS, end date will be 6 wks for Due Date
On a Clean Slate ER how much FMLA time does an EE start out w/?
12 wks. Clean Slate means they start over with all their time
Why is Honor Cert question usually only asked on Clean Slate ERs?
Because if EE says yes to Honor Cert question it suppresses the MC from being sent
What would you do if ER is Historical Takeover and EE reports there should be a claim already but you can’t find one?
If no claim and EE indicates there should be:
Script: “I see you are a new customer, welcome to Prudential. We are currently updating our claims with your prior carrier’s information. I am happy to start a claim to report any new dates of absences while we are still processing the information from your prior carrier.”
If caller questions why a new claim is needed:
Script: “Setting up a new claim ensures we can report your new absences timely to your employer. All previous information will be combined with this new claim.”
During intake please ask honor certification questions and notate for DCM
How can you find out if EE leave will be paid?
Determine which leaves will pull on to claim by reviewing ABS Summary screen. Then if you find additional (to FMLA) leaves that may apply to the situation research them in JA, ABS Rules, or Pg 2
Control # 52972 If EE calls for OSHC claim how will file it?
Not on Feed so Push thru DCMS
DBA:
No eligibility feed. Employee’s should know their branch. Assign the claim to the appropriate branch instead of the holding branch. If the employee does not know, ask probing question “What state do you work in?” to determine appropriate branch
Control #: 70680
EE adv pregnant wants to take as much time OOW as possible with pay. How much time will EE be paid?
DBA: MATERNITY PROVISION FOR ABSENCE
Appian pays birth mothers a total of 16 weeks at 100% pay based on approval of the Appian Paid Maternity leave. Includes up to 2 weeks ante partum, PP recovery, and/or comps, and bonding until 16 weeks is exhausted. Leave can be used in a max of 2 continuous blocks only. If total 16 week duration is not used in 2 occurrences, remaining leave time is forfeited
What do you tell Non Birth Parent who wants to go OOW prior to baby due date on the Bonding claim?
Bonding can not be approved until there is a baby to bond with. If your wife was medically needing you at home I could file a COFM claim for the days prior to birth or if no medical reason you could request PTO.
EE adv tweaked his knee and has to go to PT a cpl times a wk. No ABS dates yet. What leave pattern will you use?
Unknown Start Date, Unknown Pattern
EE adv will be OOW for a few wks for Mom’s surgery but it isn’t scheduled yet. What leave pattern will you use?
Add 2 wks of time 30 days in future (this policy is pending review as disability is not needed on the claim)
EE adv WS: M-F 8-5
What follow up questions do you need to ask?
Lunch Paid or Unpaid
Is that 8A or 8P
Is that your scheduled every wk
WS:
M-F 8A-5P paid lunch
M-Sa 8A-5P paid lunch
How many work sched weeks will you add if EE is reporting 4 wks OOW?
2 wks because are only 2 DIFFERENT WS
What technique do you use when EE WS is not the same every week?
Date Range Technique: This is when you ask for the work days and hrs for a specific date range
Example: You start from the Work Schedule Effective Start Date.
What days do you work from 5/22/22-5/28/22
Pregnant EE adv:
LDW: 5/2/22
FDO: 5/3/22
Due: 6/3/22
What question/s do you need to ask?
What is causing your to go OOW prior to your due date? Are you experiencing any comps?
If EE reports she has gone OOW early for PreNatal comps what ABS dates do you add?
FDO: 5/2/22
Due: 6/3/22
RTW: 11/2/22
5/2/22-6/2/22
Then transfer to Response to have the Pregnancy event and dates added to the claim
How do you determine the start date of a continuous absence?
FDO is always start date of ABS
