Suspended or Waiting Claim Status

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What is a Suspended Claim Status?

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A suspended claim status indicates that a claim is temporarily on hold, often due to missing information or documentation required for processing.

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What does Waiting Claim Status mean?

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A waiting claim status means that the claim is pending further action or information, but it is not necessarily on hold like a suspended claim.

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Who should be advised if a claim is awaiting information from the ER?

Back

The Employer (ER) should be advised if the claim is awaiting information.

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Is it true that separate review timeframes for medical do not apply on initial claim decisions?

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True. Separate review timeframes for medical are not applicable to initial claim decisions.

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What is the first step when a claim requires special handling for LTD?

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The first step is to follow special handling procedures for LTD or SHU LTD claims when applicable.

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Are Suspended and Waiting statuses used interchangeably?

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False. Suspended and Waiting statuses are distinct and not used interchangeably.

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What should you advise if a claim was previously approved and is now in waiting status?

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You should advise the caller of the previous approval date.

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What is the role of a Case Specialist in claim processing?

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A Case Specialist is responsible for managing complex claims and providing guidance on claims that require special attention.

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What information is typically required to process a claim?

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Information such as claimant details, medical records, and employer information is typically required to process a claim.

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What does LTD stand for in the context of claims?

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LTD stands for Long-Term Disability.