Helpful Tips for Effective Phone Management

I need to check the status of my claim

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Pended
o Need II
o Need medical
o Need ER statement or eligibility info
o Pended for pre ex
Approved
o Through when?
o If date has passed, then confirm what ADCM will need for
extension
Medical
Updates
RTW dates
Closed
o Date and reason
o If dates are incorrect, confirm as much info as possible and
notify ADCM of action needed
Denial/Adverse Closure
o Transfer to ADCM or VM if possible
o Transfer to complex DCM
o Explain appeals process
o Escalate if EE becomes upset or abusive.
Escalation Tree
1. Complex DCM team member first
2. Senior DCM try the team Sr. first then any Sr.
3. M1 VM if EE gives permission
4. M1

Frequently used forms

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Certification of healthcare provider form

Medical authorization form
Restrictions form
W-4 Forms

Someone called me
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CX who called and why (called for ii, called for ov follow up, notice
and proof, authorization needed)
Follow up if possible (records updates, advise of extensions, take II if
possible)
Notify the ACM of action taken or the action needed

I got a letter
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Fmla letter
Notice and Proof Letter
Denial Letter
Medical Authorization Form

Are my medical records in yet?

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EDM
Rightfax
Is there an invoice in the doc list?
My AP advised me that they faxed the records
Verify the fax numberif faxed to (603) 334-0380 then transmission
may take 24 hrs +
If faxed to ADCM direct line and records are not in EDM or Rightfax
then offer personal fax for assistance.
Offer to resend the request to AP.

What if the records have arrived but a determination has not been made?
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Records just arrived

o Advise of 72 hr review timeframe.
o Send action needed email to ADCM
Review claim notes is there a CCS scheduled?
Advise of CCS date and next steps
Is there an MDS note in?
o Advise of MDS timeframe

Where is my check?
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Check screen
o EMP = employee
o VND = Vendor
o IS = issued
o CA = Cashed
Scheduled payment screen
o Calc next check
Employee detail screen
o Direct deposit status

I have an update,
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I went to the doctor (Dates = LOV, NOV, RTW. If extension is needed

ask for a brief explanation as to why.)
I was supposed to go back to work on but I couldnt (get as much
information as possible. Why didnt you return to work? Are there
restrictions? Have you discussed accommodations with your
employer?

I work for and I have a question about

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Transfer to a member of the following teams

Christus Team Dries
University of Maryland Medical Center Team Ruane
Giant Eagle Team Miller
Unilever Team Dyer
Ryder Team Dale
South East Freight Lines Team Milne

Do not discuss payments for

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South East Freight Lines

Unilever
Bealls
Christus

Important numbers
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FMLA main line (603)750-7550

Intake line 1-(800) 713-7384
Language Lines 1-(800) 784-8207
Workers Comp 1- (800)-532-7706
Underwriting 1-(888) 287-8494 (for questions about EOI / people
trying to get STD coverage)
DUKE IVR 1-(888) 516-0747 then option 2 (EE will need RTW date
and 6 digit EE ID number)
Giant Eagle FMLA 1-(888) 892-2248 ( then press options 3-5-3)

Disability offices
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Dover Office (#0096): 1-800-210-0268

Kansas Office (#0451): 1-800-838-5290
Phoenix Office (#0913): 1-800-320-7585
Wallingford Office (0163): 1-888-440-6118

Wells Fargo (#048D): 1-866-213-2937

Wal-Mart (#088D): 1-877-353-6404