|Does Symetra credential or evaluate Third Party Administrators? If so, what is the criteria and frequency of the credentialing process?
Yes, Symetra issues a standard TPA questionnaire which is updated annually for E&O (Errors and Omissions) and general liability coverage.
|What is your average time to settle Specific and/or Aggregate claims?
||Most claims are processed in less than 5 business days. On-site Aggregate claims are settled immediately after the audit is complete.|
|What information do you require to process a Specific claim? An Aggregate claim?
||Please refer to our Administrative Guide. |
|Do you require an audit of large hospital bills?
|If hospital audits are performed, does Symetra pay for them?
||If the claimant is over the Specific deductible, we will reimburse the fee if they are based on savings of up to 30 percent. |
|What type of proof of payment is required for Specific and Aggregate claims?
|Specific claims use reports with the paid date; however, we do verify receipt of payments with providers. For Aggregate claims we refer to bank statements, check registers or ledgers. |
|What is your definition of a “paid claim?"
|A “paid claim” means that a) the covered expense is adjudicated according to the terms of the employee benefit plan, b) a check is written and mailed, or electronically deposited directly to the payee within the policy period, and c) funds are available to honor the check. To ensure funds are available, they must be deposited no later than the first working day following the end of the policy period.|
|How do you handle large claims where the group cannot fund the entire amount?
|We offer advanced funding as long as covered expenses up to the Specific deductible meet our definition of a paid claim. Please see our Administrative Guide for more information on these requirements. |
How are advanced funded claims handled? Do you reimburse, then conduct an audit? What is the turnaround time?
|Advanced fund claims are audited prior to reimbursement within the 5-day turnaround goal. Symetra will accommodate rush requests when notified at time of claim submission.|