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Benefit Eligibility And Case Management Services

Claims Eligibility Decision Support 
Comprehensive claims administration by a team of experienced and skilled long-term care insurance professionals. Claims adjudication support and insights on claims decision recommendations by industry recognized LTCi experts results in increased confidence in the adjudication process.
Customer Dispute Resolution Support (Escalated Matters)
Administrative services to research and resolve policy and related complaints and disputes. Manage matters escalated for special handling and/or addressing outside of routine processing. Implement resolutions to complaints and disputes and special handling circumstances with focus on enhancing policyholder experience through clear communication.
Case Management Consulting
Consulting services to evaluate current processes, procedures, and workflow, and recommend case management improvements. Project management and support services are also provided to implement recommendations associated with the case management functions. Supporting technology evaluations can be performed to identify efficiency, security, and improvement opportunities, with follow-up action plans and implementation support.

Consulting Medical Director
Benefit eligibility, plan of care determinations, general case management evaluation services, and formal and informal medical reviews are provided by Fuzion’s Medical Director. Service also includes physician-to-physician discussions to assist in evaluations and determinations.
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