LTC Claims Administration Toolbox
Telephonic Assessment Tool
A. Introduction
This section of the Toolbox features a telephonic version of the Condensed Reassessment Tool.
The Telephonic Assessment does not include all of the categories included in the Condensed
Reassessment Tool. The Telephonic Assessment Tool obtains information about the insured’s
functioning and cognitive ability, as well as their life and home situation. It is an instrumental tool
in the management of home health care, Assisted Living and Nursing Home benefits. This tool is
intended to provide the insurer with information sufficient to:
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Verify that benefit eligibility triggers continue to be satisfied;
Verify that the plan of care continues to be appropriate for the insured’s needs; and
Identify any unreported changes in the insured’s care providers or level of care.
It should also be noted that this tool is intended to be used to gather information from the provider
of services and would not be appropriate if direct contact with the insured or their representative
is needed.
B. Discussion
Only 6 of the 8 categories used in the Condensed Reassessment Tool are represented in the
Telephonic Assessment Tool. The categories are:
Personal History
Medical History
ADL Profile
IADL Profile
Behavior and Cognitive
Caregiver
In the Condensed Assessment Introduction, where applicable, we provided commentary and tips
on incorporating information obtained into the overall assessment of the claim by the insurer. As
such commentary and tips are also applicable in connection with the Telephonic Assessment we
have provided them here, as well.
If physical or occupational therapists have been providing services it would be helpful to obtain an
update from the therapists on the insured’s progress and anticipated timeline to achieve
established goals, especially if those goals include independence with ADLs.
C. Telephonic Assessment Tool
The sample Telephonic Assessment Tool included in this section provides LTC insurers with
ideas of what could be incorporated in their Telephonic Assessment tool. Definitions are broad
and must be tailored to match the definitions of the individual company’s policies if any or all parts
of the tools are used. The simple style of formatting used is purposeful so that the tool can be
easily replicated or reformatted if an insurer is interested in using any of this information in their
own telephonic assessment tool.
The sample Telephonic Assessment Tool shown here addresses only those areas related to
gathering functional and cognitive information, as well as other critical pieces of information,
required to verify continued benefit eligibility and to update a plan of care specific to the insured’s
changing needs. It does not include pages that would provide policy information or any
information the insurer might obtain relating to the assessor or the third party administrator.
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LTC Claims Administration Toolbox
Telephonic Assessment Tool
D. ADL Assessment
The information collected in the Activities of Daily Living (ADL) section will typically be reported by
the care providers. Information obtained is used for care planning purposes to ensure previously
established goals remain appropriate and achievable. If the insured is in an assisted living or
skilled nursing facility, the assessor could request a copy of the facility’s current plan of care or
medical records if necessary
E. Cognitive Assessment
The information contained in this section of the Introduction is not the same as
that shown in the Introduction for the On Site Assessment Tool and the
Condensed Reassessment Tool.
Behavioral and Cognition Assessment
The Behavioral and Cognition Assessment questions used in this section need to be clear and
include detail instructions to elicit sufficient information about the insured’s cognitive ability. This
may help limit interpretive errors by the assessor conducting the Telephonic Assessment and
reduce variability across assessors for determining if the benefit triggers have been met.
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