Basic Claims Training Webinar: FAQs and Highlights

TAI customers can make the most of the system’s Claims module with these helpful tips from Ryan Cauldwell, Manager of Reinsurance Consulting. In his recent TAI Basic Claims Training Webinar, Ryan walked attendees through frequently asked questions on the claims module’s functionality and highlighted its most popular features.

This overview follows the traditional claims process, including some gross net and rescission claims, to help existing users polish their skillsets and offer insight for those looking to implement the TAI Claims module in their workflow. The module is not an adjudication system but instead tracks claims and provides reporting from initial notice all the way through to the request for payment.

Read on for highlights. For the full recap, you can log in to TAI’s Help Desk in the Knowledge Base.

FAQ: TAI Claims Module

Can claims processing be automated within TAI?

Claims may be processed without any customization. Automation is possible through an admin or claims system extract.

The TAI Claims module is equipped to process claims, but further customization is required to address specific requirements or questions. Some clients have implemented a separate extract from their claims system into TAI to automate processing further. There are many possibilities, and our team is happy to discuss a solution that works for you.

How are rescinded claims handled in TAI?

A claim rescission is treated like a benefit instead of a billing reversal. The rescission process will re-finalize the claim, taking back all of the premium and allowance that was paid according to the billing history for the given cession.

This process might be helpful if there is a misrepresentation on the policy or some other problem. Treating rescinded claims as a benefit allows you to continue with the claim record—rather than reinstating the policy, it reverses the billing records and wipes out the claim record. It helps you keep the paper trail, but since the claim will now treat this as a benefit, it will look back and try to recover all reinsurance premiums paid on the system.

Note: TAI can only recover premiums billed on TAI, so policies converted onto TAI where full billing records were not moved over would require a manual adjustment to rescind the claim fully. Also, if a continuation was involved, and those premiums need to be recovered, a manual adjustment would be required as well.

Upon execution of a rescission, the claim will be reset to Finalized Status, and the claim amount will now reflect the summation of ALL billing records in the cessions billing history. 

Is there an enhanced claims extract available?

Yes, this enhanced Electronic Claims EDI Extract Layout is standard with versions 3.40 and later. This extract is run in the TAIB300 program and pulls information from the claims summary, claims detail, transaction, and living benefits claims tables.

This standard format, similar to billing transaction files, helps reinsurers ingest the information more easily than usual text files do.

This option does come standard within versions 3.4 and later. It is configurable within the 3.0 and higher versions but would require a small project to complete the configurations.

There is also a claims flow extract that details the cession level payment detail from the reinsurers back to the ceding companies. This extract helps streamline and automate the request for payment and payment collection process between parties.

TAI Claims is ready to go out of the box—no customization needed— but there are endless possibilities. If you’re interested in enhancing your automation capabilities or creating a more customized solution to meet your needs, do not hesitate to get in touch.

Log in to Help Desk to access the full TAI Basic Claims Training Webinar recap.