LTC Claims Toolbox
Nursing Home Benefit
Establishing Provider Eligibility
A. Introduction to Nursing Home Benefit – Establishing Provider
Eligibility
A1. Introduction
This unit identifies key areas of interest to help LTC claim managers develop claim
procedures related to collecting pertinent documentation and critical information needed to
determine a nursing facility’s eligibility under the terms of an LTC policy.
The areas included here are:
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Expectation Management - Helping agents understand what they are selling and
helping policyholders understand what the benefit is under the policy they have
purchased.
Web Sites – Providing that keep managers up to date with links to federal and state
web sites and other informational sites of interest.
Sample Facility Questionnaires – An overview of criteria used in the industry and
several sample questionnaires some of which can be completed by the facility or
others by an independent assessor.
State by State Listing of LTC facility definitions - Provides a snapshot, as of summer
2006, of definitions as specified in Health and Human Service regulations and as
specified in state insurance regulation.
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