FINEOS Claims for Long Term Care

The average life expectancy has risen significantly in the last few years.  While this is good news, it also means an increase in the need for long term medical care and insurance coverage. Insurers can take advantage of this growing market need – as long as they can handle the associated rise in claims volumes without sacrificing service.

FINEOS Claims for Long Term Care has been engineered to help you streamline operations while improving service levels for increased customer satisfaction.

Greater Operational Management of Long Term Care Claims

FINEOS Claims for Long Term Care supports complete plan of care management, allowing you to direct claim activity toward the desired outcome.  The solution is integrated with expert third-party databases to help claims handlers closely monitor return-to-work scenarios and to raise alerts when thresholds have been reached.  It also allows manual adjustments to policy limitations to accommodate changes or additions to the plan of care. 

FINEOS Claims for Long Term Care uses business rules to ensure appropriate task routing and service prompts, enabling handlers to closely monitor claim progress and take actions on outstanding claims as necessary.  The plan of care management features within the solution deliver all relevant information to claims handlers in a single system, providing them with the data they need to make informed decisions and speed the resolution of a claim. 

Improved Customer Service

FINEOS Claims for Long Term Care provides a real-time, single view of the customer, empowering claims handlers to deliver individual service over any channel.  This allows representatives to understand all aspects of a long term claim and provide information on the comprehensive plan of care.

Using electronic file management, FINEOS Claims for Long Term Care allows claims to be associated with extended parties, enabling representatives to respond appropriately to inquiries from relatives or caretakers of the policy holder.

Comprehensive Financial Management including Provider Utilization

FINEOS Claims for Long Term Care allows you to manage providers such as nursing homes, hospice workers and physical therapists, enabling you to automate ordering of services and management of invoices. The solution’s comprehensive financial management capabilities quickly review claims against specific criteria and plan of care, ensuring quick and appropriate payment.  It can also be configured to schedule payments on portions of claims that fall within approved parameters and place additional payments in a pending status for review at a later date. 

FINEOS Claims for Long Term Care allows the establishment of automatically recurring and complex payment structures and integrated invoice processing and supports manual adjustments to policy limitations.  It supports benefits accumulators, allowing claims handlers to view data regarding determination of the time or monies used and/or remaining, and whether or not benefits may be restored. 

FINEOS Claims for Long Term Care also allows you to report on provider utilization, enabling you to monitor providers’ performance, rates and fees.  The solution can be configured to trigger alerts when invoices or service do not match existing agreements.

Comprehensive Documentation and Auditing

As long term care insurance often deals with sensitive matters, the difference between a good experience and a difficult one frequently boils down to clear information regarding care and benefits.  FINEOS Claims for Long Term Care provides automatic documentation and correspondence generation, ensuring that all appropriate forms are created and distributed. 

The solution delivers comprehensive document and activity auditing, allowing you to report on claim status and processes and ensuring compliance with internal and regulatory guidelines and standards. 

FINEOS Claims for Long Term Care goes beyond traditional claims processing to deliver all aspects of a total claims solution:

  • Fully automated claims and case management
  • Integrated customer management
  • Comprehensive financial management
  • Optimal provider management
  • A flexible, modern, rules-driven technology platform