Claims Handling
Claims Handling 

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arrowDeath Claims Processing
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Claims handling in FIMMAS consists of four elements:

  1. Claims entry and determination of eligibility
  2. Claims adjudication (calculation of payment)
  3. Disbursement processing
  4. Claims tracking, inquiry and reporting
 

FIMMAS handles all four of these elements for life, AD&D, and disability products. For medical and dental products, FIMMAS provides elements 1, 3, and 4, with an interface to specialized systems for claims adjudication.

In other words, FIMMAS manages claims for all types of products. It creates the claim record, checks eligibility, and passes eligible claims to the appropriate claims adjudication system (FIMMAS for life, AD&D, and disability; an external system for medical, dental, vision, and prescription drugs products).

Once the claims adjudication system has calculated the payment, the payment information is returned to FIMMAS, which creates the disbursement, allocates the disbursement to appropriate General Ledger accounts, and updates the client database to reflect the payment. The FIMMAS database then retains all transaction detail for tracking of claims history and payment history. All detail is available for inquiry and reporting. Detail records are retained on-line until you decide to archive or delete them.

 

Death Claims Processing

FIMMAS provides an on-line Death Claim Register. The claim may be recorded when it is reported. The claim record is automatically updated when the claim is paid. Features specific to Death Claim processing include the following:

  • FIMMAS provides a quotation screen for calculating and displaying the Net Death Claim as of a specified date.
  • Death claim calculations split the amount of insurance into net mortality and reserve released components.
  • FIMMAS calculates interest on death claims. Interest parameters may vary by state. These rules are user-maintained.
  • FIMMAS provides Requirement Tracking capabilities that may be used to order and track requirements for a death claim, or for other types of claims or service requests.
  • FIMMAS supports joint insured coverages, including standard joint coverages as well as last survivor coverage.
  • When a death claim is reported, billing and other policy activities may be suspended.
  • A pending claim may be reversed or denied.
  • Appropriate reinsurance and accounting transactions are recorded.

 

Repetitive Payments Processing

FIMMAS provides repetitive payments processing for a variety of products including:

Short Term and Long Term Disability
Structured Settlements
Addresses
Life Benefit Payout
Deferred and Immediate Annuities
Supplementary Contracts 


  
The Repetitive Payments capabilities of FIMMAS include:

  • Searching for existing claims by Claim Number, Contract Number, Client ID, Group ID, and Claim Status.
  • Adding new claims, automatically calculating payments, and setting up payments into payment streams.
  • Approving, denying, contesting, resisting, suspending, recertifying, and terminating claims and payments.
  • Pre-scheduling payment changes, such as Social Security, Workers Compensation, and residual offsets.
  • Managing exclusions and federal and state tax withholdings.
  • Multiple payment modes, including weekly, bi-weekly, monthly, bi-monthly, quarterly, semi-annually, and annually.
  • Single or multiple payees or assignees.


Click here for more information about Repetitive Payments Processing.