Evidence Eval

Waiting Period Eligibility Dates

If you select 'Yes' there will be a pop-up next to the question prompting you to request documents and create the 'obtain documents' task, which will automatically be assigned to a vendor agent. A 'Review Documents' task will be created and assigned to the Claim Advocate upon completion of the 'Obtain Documents' task to review the documents received the ensure they are what was needed.

✨ Pro Tip

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NOC or EOB

This is if we have seen evidence in medical records or in the pet medical history tab general details (as shown to the right) that the pet may have had dual coverage or prior insurance so we either need confirmation of cancellation or the EOB from the primary insurer.

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Additional Documents

This is if we're missing any medical records (date of loss (DOL) or complete records), that we need to make an accurate claim determination. Your answer (Yes or No) will determine your next steps!

Medical Record Review

This is if a full Medical Record Review (MRR) is necessary(based on your claim investigation). If 'Yes' is selected for this question after the records are obtained, the Review Medical Records task will automatically open and be assigned to an MRR Assosiate

Full Medical Records

We talked about what full medical records are in the Claim Documentation course, but below is a quick reminder when it comes to a claim:

• All MR confirmed for the insured pet.
• Detailed SOAP notes (Subjective, Objective, Assessment & Plan)
• All MR from 12 months pre-policy through the end of the IWP from the DOL hospital
• All MR from 12 months pre-policy through the end of the IWP from all hospitals visited on prior claims
• All MR from 12 months pre-policy through the end of the IWP from all hospitals where the PH has previously sent in information (found in the Medical Records section, often MR sent in at time of enrollment)
• Confirm the number of hospitals you are requesting MR from matches the number of hospitals the customer stated they visited at time of enrollment