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STD/LTD/Leave Administration

STD/LTD/Leave Administration. BMS/Amylin Training – Transition to The Hartford March 27, 2014 Kathy Brooke. Background.

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STD/LTD/Leave Administration

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  1. STD/LTD/Leave Administration BMS/Amylin Training – Transition to The Hartford March 27, 2014 Kathy Brooke

  2. Background • AZ has partnered with The Hartford to provide short term disability (STD), long term disability (LTD) and leave management services to provide an integrated leave management service. • Effective on April 1, 2014 Hartford will administer all Diabetes Franchise Transition Employees and Amylin Leave of Absence and STD/LTD claims. Process: • Employees call The Hartford at 877-497-8950 to file a claim. Special Note: • AZ initiated administrative leave will not be handled by The Hartford.

  3. Roles and Responsibilities Set area descriptor | Sub level 15

  4. The Hartford AZ/MedImmune Employee Claim Filing Form Set area descriptor | Sub level 1

  5. STD & Leave Management (LM) Depending on Triggers from STD System, AC will take the following actions, as appropriate 5 business days prior to the end of the approved continuous leave period, the AC will call the employee to determine whether they are returning to work or will need to extend their leave. System generates a letter notifying the Employee & Employer of the outcome of the RTW call. • AC makes eligibility decision & system generates employee packet of information including: • Initial claim letter • FMLA Eligibility and Rights & Responsibilities Notice • Appropriate Certificate of Healthcare Provider form (CHCP) for stand alone leaves only • System sets tasks for 15 day determination & return to work call out. AC makes leave determination based on certifying documentation or information received from STD. For standalone leaves, this includes the incomplete and insufficient CHCP and late medical certification process. System sends designation notice for federal and/or state leaves. If an extension is requested, the employee is asked to provide a CHCP within 15 business days. If necessary, System will generate extension notice to claimant based on new leave end date. System sets 15 day determination task & return to work call out. Absence Coordinator (AC) confirms information from feed, gathers necessary information to initiate leave event and answers employees questions. Reporting Leave Only Real time system triggers from STD system which initiate leave management workflow (includes setting tasks for AC) Employee calls single 800 number • LM process continues until the employee: • Returns to work; • Does not provide timely certifying documentation; or • Exhausts available leave time – system generates the following notifications upon exhaust of the last job protected leave:10 days prior - Approaching Exhaust letter sent • Day of - Final Exhaust letter sent Reporting STD with Leave • STD claim continues until employee: • Returns to work • No longer meets the definition of disability • Exhausts available STD benefits When necessary, STD Intake makes two attempts to gather medical information from physician. If unsuccessful, Ability Analyst calls employee on business day 4. STD Analyst receives completed claim and makes determination. STD Intake gather necessary STD claim information and advises claimant this will also begin the leave claim. Confidential & Proprietary – The Hartford

  6. Day 0 Day 4 Day 15 STD: Notification of Telephonic Clinical Intake If claim requires clinical intervention, a diary is created for a clinical touchpoint to Return-to-Work Coordinator, Medical Case Manager, or Behavioral Case Manager Nurse intakeresponsible forcollecting necessaryEmployee andPhysicianinformation Medical details Complete? Peer to Peer communications between Nurse Intake and Physician as needed Employee callsin claim Yes Intake Complete No In the event the Peer to Peer communication is not successful, the employee is notified on the 4th day via telephone. If we are not able to make contact, then a letter is sent to the employee APinformation Received by Day 15? Claim closed (closure letter sent); Claim reopened if necessary information is received Confidential & Proprietary – The Hartford

  7. Worker’s Compensation (WC) Process Overview Employee contacts the onsite clinic to report a work injury Clinic staff takes claim info; contacts Broadspire for WC Directs the employee to call Hartford if a disability claim Employee contacts the HR Service Center and is redirected to the onsite clinic Broadspire initiates a file – sets up claim #, takes billing information for AZ Broadspire reports state wage to AZ payroll • If employee calls Hartford first for a disability claim, Hartford directs the employee to call the clinic to start the WC claim • Employees should not call Broadspire directly to file WC claims except after normal clinic business hours. AZ payroll pays the % instructed by Broadspire and supplements to 100% Hartford initiates disability claim Offset coordination Broadspire Off hours claims 1-888-498-7123 Broadspire issues the check to AZ or employee • AZ nurse assists with employee return to work through coordination with the onsite clinic, Broadspire and Hartford • AZ onsite clinic records reportable events in OSHA log

  8. Tools and Resources Manager Tools and Resources Document will be posted to the portal: • AZ LOA and Disability Flyer • Located at www.myazbenefits.com • US intranet, Health & Wellbeing page, tools and resources at: https://www.em.azcollaboration.com/hr/BAU/ENG/Shared%20Documents/Health%20and%20Wellbeing/AZ_DisabilityDirection%20Flyer_Q.pdf • AZ LOA and Disability Resource Document • Links to AZEngage Manager and Employee Checklists • Links to AZ policies • Link to AZ WC information • US Worker’s Compensation Process • Link to UK Insurance intranet page: http://youraz.astrazeneca.net/portal/site/AZ/menuitem.c7aa7046082fd41ff2716efec21029a0/?vgnextoid=ec3e116ae44b6210VgnVCM2000003401920aRCRD Set area descriptor | Sub level 1

  9. Appendix • Worker’s Compensation Work Flow Chart • Broadspire process for all US states except OH, ND, WA & PR • OH, ND, WA & PR Claims are filed directly with those states • AZ Internal Nurse Managed Process During Regular Clinic Office Hours Set area descriptor | Sub level 1

  10. Claim is submitted to Broadspire’s intake system TELEPLUS 1-888-498-7123 Claim is transferred to a lost-time specialist if lost time occurs Indemnity claim: Claim specialistinitiates investigation CIB Automatically Filed. 6 Month Intervals Claim specialist uses Claims Advantage to make three-point contact with employee, employer and treating physician within 24 hours Claim analyst makes written contact with employee and treating physician Based on obtained information, the claim specialist sets the appropriate reserves and continues the investigation Claim specialist makes compensability decision and takes further action based on that decision. Close file Normal Business Hours Broadspire WC Claims Process AZ Nurse Triage Claim information loaded into the claim handling system and all information is forwarded to the appropriate claim office Medical only claim: Assigned to a medical claim analyst who makes initial contact with the employer Team manager reviews the claim and assigns it accordingly Coordination AZ/MedI Payroll &Hartford & LMT Telephonic or field case managers assigned CIB Filed Automatically 6 Month Intervals Review for subrogation potential Review for fraud potential Monitor medicaltreatment If claim denied files notice to controvert File state-required notices as applicable Commence Med. & Disability Mgmt PPO, MBR, UR, RX Notifies team manager if lost time occurs File state-required notices as applicable Issue appropriatebenefits payments Note: Process not applicable for WC claims in OH, ND, WA and PR. If no Lost Time. File Closed Manage litigation Resolve case

  11. AZ Internal Worker’s Compensation Process Nurse Managed Triage Process Note: Claims reporting outside normal clinic hours are reported To Broadspire at 1-888-498-7123

  12. Questions ????? Set area descriptor | Sub level 1

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