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Whether offered as a supplemental group coverage, voluntary employee benefit, or individual contract, our solution to Long Term Care offers an exciting, new marketing opportunity. With software from Apex Data Systems designed especially for LTC, you can be ready to meet the challenges of quickly bringing new products to market, managing new business sales volumes, providing cost effective and efficient enrollment and billing processes, and offering quality claims and customer service support.
Administration Capabilities
Our consolidated administration system provides you with total administration support for enrollment, policy/certificate issue, billing, premium collection and accounting, agent commissions, and detailed reporting. Our Long Term Care Administration module can be utilized in conjunction with the administration of other coverage types such as life, disability, or health products, or as a stand-alone package. Advantages offered by Apex Data Systems' Long Term Care software include:
A dynamic enrollment structure that allows for base and rider coverages with separate inception and termination dates, premium amounts, and payment transaction records. Flexible billing features including individual direct bill, individual list bill, and group bill capabilities. Processing allows for covered spouses, and even other family members, to be billed together or separately. Policyholders can be linked and unlinked quickly and easily. Electronic Funds Transfer features that allow for fully automated Pre-Authorized Checking and bank drafts. A Personal Benefits Selection file that captures unique daily and monthly benefit amounts, elimination periods, benefit periods, and other policy provisions, all available for selection by the insured. Rating load and discount factors that are available for substandard and preferred business. Single or dual pool benefit amounts (2 lifetime "pots of money") available by insured. Premium waiver features allowing for premiums to be temporarily or permanently suspended. A shared benefits indicator allowing for a common maximum between spouses when both spouses are covered for benefits, plus appropriate premium discounts.
Claims Capabilities
Our consolidated claims system allows for a seamless tie between claims eligibility and adjudication. All features of Apex Data Systems' claims management system are available when processing LTC benefits including online eligibility verification, pending and correspondence modules, benefit processing by user-defined plan tables, actuarial and lag studies, premium/claims analyses, and other reports. The system allows for, among an array of other features, multiple payments per claim to the insured, multiple vendors/providers, PPO/EPO integration, coordination with Medicare, and batch check issuance with full itemization. Features highlighted for LTC processing include:
Acceptance of the initial notification of claim as received from the insured or a family member, with documentation to the file. Upon receipt of notification, the generation of appropriate claims forms with follow-up correspondence based on user-defined parameters and letters. Availability of personal benefit selection records. Maintenance of episode and submittal claims data with incurred dates. Listings of applicable ADLs, and SPMSQ scores and number of errors, with tracking for claimant eligibility and history purposes. Capture of critical behaviors including wandering, abusive/assaultive, poor judgment, and bizarre hygiene. Capture of detailed nurse-reviewer notes and plan of care, along with an assessor ID. User defined claims adjudication plans. State-related benefit overlay records that automatically engage based on the state code of the insured.
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