Disability and Life Online Claims Submission

Transcription

1 Disability and Life Online Claims Submission User Manual for Employers 38177CAEENABC 06/13 The contents of this manual should not be considered legal advice or recommendations. You should work with your company s attorney when interpreting your company s legal responsibility under your employee disability and life plan(s). You should also review applicable state and federal laws and regulations. The contents of this manual may change or be updated at any time.

2 Table of contents Overview 4 Submitting a Life Insurance claim 5 Submitting an Accidental Dismemberment claim 14 Submitting a Living Benefit claim 21 Submitting a Life Waiver of Premium claim 28 Submitting a Short Term Disability claim 35 Submitting a Long Term Disability claim 44 Checking claim status 53 Getting statistics reports Life and Disability 59 2

3 Introduction Disability and Life claims submission at anthem.com/ca your one-stop claim administration web portal. We re making it easier for you to do business with us. In addition to the helpful resources already available at anthem.com/ca, our online disability and life claims submission site provides: A convenient way for you to submit claims on behalf of your employees. Fast response times. Status reports to keep you up to date. We offer you control over your life and disability claim information and accuracy. Error messages signal missing or incomplete information, and electronic prompts guide you from one step to the next. This manual offers step-by-step instructions on how to use disability & life online claims effectively. If you have questions, call: For life claims: For disability claims: Or, call your group s dedicated Case Manager. 3

4 Welcome To access online Disability and Life Claims Submission, go to anthem.com/ca and select the Employer tab. Then click Submit a Disability and/or Life Claim to access the online claims site. You ll select the type of claim you want to submit on the Welcome screen. The options are: Life Accidental Dismemberment Living Benefit Life Waiver of Premium Short Term Disability Long Term Disability Fields marked with an asterisk* are required. 4

5 Submitting a Life Insurance claim When you select Life in the Type of Claim field, you ll need to select if you are submitting a claim for an Employee or Dependent. This example is for an Employee claim. The process is the same to submit a Dependent Life claim. In the Type of User field, select Employer. Enter the characters you see in the bottom box, then click Next. 5

6 If you don t already have it, you can print the additional form needed to process the claim from this screen. Click on the link to get a fillable PDF copy of the Beneficiary Claim Form. This screen also explains any other information you will need to submit so we can finalize the claim. 6

7 You ll enter your contact information on the Employer Information screen. 7

8 On the Employee Information screen, you ll give us the information we need to begin processing the life claim. 8

9 If available, enter the beneficiary information here. You will click the Add Beneficiary button for each beneficiary on file (see next page). 9

10 This is where you enter the beneficiary information. We will still need a copy of the most recent Enrollment Form or the most recent Beneficiary Designation Form. 10

11 This screen allows you to upload any additional forms and documents. For example, if you have the Enrollment or Beneficiary Designation Forms, the completed Beneficiary Claim Form(s), and/or the death certificate, you can upload them here. Simply click the Browse button, select your forms, and then click Upload. 11

12 On this page, you can review the information you have entered. You must also acknowledge the legal statements here. You can enter your address and we ll send you an confirmation of all the information you entered. You can also enter any additional comments pertaining to the claim in the box below. 12

13 Once the claim is complete, you ll receive a confirmation summary showing all the information you entered, along with a Claim Reference number. You can use this number when checking the status of a claim. If you entered your on the prior screen, you ll also get a confirmation summary by . 13

14 Submitting an Accidental Dismemberment claim To submit a claim for an accidental dismemberment, select Accidental Dismemberment in the Type of Claim field. In the Type of User field, select Employer. Enter the characters you see in the bottom box, then click Next. 14

15 You can print the forms we need to process the Accidental Dismemberment claim from this screen. Click on the links to get fillable PDF files of the forms: Employee s Statement Attending Physician Statement 15

16 You ll enter your contact information on the Employer Information screen. 16

17 On the Employee Information screen, you ll give us the information we need to begin processing the Accidental Dismemberment claim. 17

18 If you have completed forms at the time you enter the claim, you can scan them and upload them on this screen. For example, if you have the Employee s Statement and/or Attending Physician Statement, you can scan and attach them here. 18

19 Next, you ll get confirmation of the information you entered and you ll give your certification to us so we can begin processing the claim. You can also enter your address and we ll send you confirmation of all the information you entered. 19

20 Once the claim is complete, you ll receive a confirmation summary showing all the information you entered. If you entered your on the prior screen, you ll also get a confirmation summary by . 20

21 Submitting a Living Benefit claim To submit a claim for a Living Benefit (Accelerated Death Benefit), select Living Benefit in the Type of Claim field. In the Type of User field, select Employer. Enter the characters you see in the bottom box, then click Next. 21

22 You can print the forms we need to process the Living Benefit claim from this screen. Click on the links to get fillable PDF files of the forms: Employee s Statement Attending Physician Statement Disclosure Statement 22

23 You ll enter your contact information on the Employer Information screen. 23

24 On the Employee Information screen, you ll give us the information we need to begin processing the Living Benefit claim. 24

25 If you have completed forms at the time you enter the claim, you can scan them and upload them on this screen. For example, if you have the Employee s Statement, Attending Physician Statement, and/or Disclosure Statement, you can scan and attach them here. 25

26 Next, you ll get confirmation of the information you entered and you ll give your certification to us so we can begin processing the claim. You can also enter your address and we ll send you confirmation of all the information you entered. 26

27 Once the claim is complete, you ll receive a confirmation summary showing all the information you entered. If you entered your on the prior screen, you ll also get a confirmation summary by . 27

28 Submitting a Life Waiver of Premium Claim To submit a claim for a Waiver of Premium for life insurance, select Life Waiver of Premium in the Type of Claim field. In the Type of User field, select Employer. Enter the characters you see in the bottom box, then click Next. 28

29 You can print the forms we need to process the Life Waiver of Premium claim from this screen. Click on the links to get fillable PDF files of the forms: Life Waiver of Premium Employee s Statement Life Waiver of Premium Attending Physician Statement 29

30 You ll enter your contact information on the Employer Information screen. 30

31 On the Employee Information screen, you ll give us the information we need to begin processing the Life Waiver of Premium claim. 31

32 If you have completed forms at the time you enter the claim, you can scan them and upload them on this screen. For example, if you have the Life Waiver of Premium Employee s Statement or Life Waiver of Premium Attending Physician Statement, you can scan and attach them here. 32

33 Next, you ll get confirmation of the information you entered and you ll give your certification to us so we can begin processing the claim. You can also enter your address and we ll send you confirmation of all the information you entered. 33

34 Once the claim is complete, you ll receive a confirmation summary showing all the information you entered. If you entered your on the prior screen, you ll also get a confirmation summary by . 34

35 Submitting a Short Term Disability claim To submit a claim for Short Term Disability, select Short Term Disability in the Type of Claim field. In the Type of User field, select Employer. Enter the characters you see in the bottom box, then click Next. 35

36 You can print the forms we need to process the Short Term Disability claim from this screen. Click on the links to get fillable PDF files of the forms: Attending Physician Statement Individual Authorization Form Reimbursement Agreement 36

37 You ll enter your contact information in the Employer Information section of this screen. Also enter the employee s contact information and all the information you have about their disabling condition. 37

38 Be sure to give us as much information you have about the employee and their disabling condition. 38

39 Enter further information about the disabling condition on this screen. The questions will change based on the Reason Stopped Work chosen: Illness Injury Maternity Unknown 39

40 If you have completed forms at the time you enter the claim, you can scan them and upload them on this screen. For example, if you have the Attending Physician Statement, Individual Authorization Form, and/or Reimbursement Agreement, you can scan and attach them here. 40

41 Next, you ll get confirmation of the information you entered and you ll give your certification to us so we can begin processing the claim. You can also enter your address and we ll send you confirmation of all the information you entered. 41

42 Once the claim is complete, you ll receive a confirmation summary showing all the information you entered. If you entered your on the prior screen, you ll also get a confirmation summary by . 42

43 (Continued) 43

44 Submitting a Long Term Disability claim To submit a claim for a Long Term Disability, select Long Term Disability in the Type of Claim field. In the Type of User field, select Employer. Enter the characters you see in the bottom box, then click Next. 44

45 You can print the forms we need to process the Long Term Disability claim from this screen. Click on the links to get fillable PDF files of the forms: Attending Physician Statement Individual Authorization Form Reimbursement Agreement 45

46 You ll enter your contact information in the Employer Information section of this screen. Also enter the employee s contact information and all the information you have about their disabling condition. 46

47 Be sure to give us as much information you have about the employee and their disabling condition. 47

48 Enter further information about the disabling condition on this screen. The questions will change based on the Reason Stopped Work chosen: Illness Injury Maternity Unknown 48

49 If you have completed forms at the time you enter the claim, you can scan them and upload them on this screen. For example, if you have the Attending Physician Statement, Individual Authorization Form, and/or Reimbursement Agreement, you can scan and attach them here. 49

50 Next, you ll get confirmation of the information you entered and you ll give your certification to us that we can begin processing the claim. You can also enter your address and we ll send you confirmation of all the information you entered. 50

51 Once the claim is complete, you ll receive a confirmation summary showing all the information you entered. If you entered your on the prior screen, you ll also get a confirmation summary by . 51

52 (Continued) 52

53 Checking claim status You can check the status of claims submitted for your employees online using the secure portal. We will provide a user name and temporary password for you. Only group administrators can check claim status, or the designated representative (TPA). Employees do not have access to check claim status. If you are having problems logging into your account, please call ext

54 The first time you log on with your temporary password, you will be promoted to change your password. You will then get confirmation that your password was changed. The first time you log on, you will also need to complete your profile. 54

55 To check the status of submitted claims, click Claim Search. If you have a question about a specific claim, contact the Life and Disability Service Center at If you have a question about your reporting, contact the Life and Disability Reporting area at ext

56 You can search for a claim by: Social Security number. Reference number the number provided when the claim was entered online. Claim number assigned by us. Type of Claim. Claim Status. Only Type of Claim and Claim status are required. If you have a question about a specific claim, contact the Life and Disability Service Center at If you have a question about your reporting, contact the Life and Disability Reporting area at ext

57 You can search for open claims, closed claims, or all claims for your group. Enter the date range for which you d like to see claim status. If you have a question about a specific claim, contact the Life and Disability Service Center at If you have a question about your reporting, contact the Life and Disability Reporting area at ext

58 You can review claims online or export the claim report to Excel. Click the button above the list of claims to export the information to an Excel file. JILL JONES JILL JONES DAVID ANDERSON JOHN SMITH MARY BROWN LINDA MILLER 58

59 Getting statistics reports Life and Disability You can get reports of the life and/or disability claims for your group. Only group administrators can access statistics reports, or the designated representative (TPA). Employees do not have access to reports. To access your disability claims statistics report, click Group Statistics Reports for Disability Claims. To access your life claims statistics report, click Group Statistics Reports for Life Claims. If you have a question about a specific claim, contact the Life and Disability Service Center at If you have a question about your reporting, contact the Life and Disability Reporting area at ext

60 To perform a search on the Employee Disability Claims Status page: Enter the activity range start and end dates in the From Date and Thru Date fields. Select Search. Searches will only display 12 months of results. If you have a question about a specific claim, contact the Life and Disability Service Center at If you have a question about your reporting, contact the Life and Disability Reporting area at ext Select the claim type you want to find from the CLAIM TYPE drop down box: Short Term Disability (STD) Long Term Disability (LTD) Enter the activity range start and end dates in the From Date and Thru Date fields and select Search to prompt a search. 60

61 You can review the report online or export the report to Excel. Click the button above the list of claims to export the information to an Excel file. Here is a sample Group Statistics Report for Disability Claims: If you have a question about a specific claim, contact the Life and Disability Service Center at If you have a question about your reporting, contact the Life and Disability Reporting area at ext

62 Here is a sample Group Statistics Report for Life Claims: If you have a question about a specific claim, contact the Life and Disability Service Center at If you have a question about your reporting, contact the Life and Disability Reporting area at ext

63 Life products underwritten by Anthem Blue Cross Life and Health Insurance Company; Disability products underwritten by Anthem Life Insurance Company. Independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. anthem.com/ca 63