State Medical Insurance Services
Sohema provides modules to meet the needs of several business functions in public insurance organizations. The following modules are currently available:
- Third Party Liability Recovery including: Casualty,Estate
- Casualty Recovery
- Enhanced Coordination of Benefits and Premium Assistance
- Disability Evaluation Services
Third Party Liability Recovery
Estate Recovery involves the recovery of insurance claims from estates. Sohema’s modules for Estate Recovery enable workers to track all of the related recovery processes related to:
- Special Needs Trusts
- Asset Verification
Estates a type of probate estate recovery applied to members in receipt of Medicaid benefits while over age 54 or while institutionalized. Sohema manages and records case details, case requests, type of referral source, requests to defer, deny or waive recovery, and visits to Probate Court.
Annuities a type of estate recovery used to repay long term care benefits when a member purchases an annuity and the state is named the primary beneficiary. Manages and records case details, referral source, annuity details, beneficiaries, and Registry of Deeds requests.
Liens identifies and records Medicaid members in long term care who own real estate, and manages the process of applying a lien to the property. Manages and records lien case details, referral sources, details of a lien, pending, denied, or granted appeals to liens, and requests for Registry of Deeds research. Also enable users to release a lien.
Special needs trusts manages the recovery of funds remaining after the death of the trust’s beneficiary. Manages and records the case details, referral source, trust details, and trustees (added as a type of case participant).
Asset Verification aids in the cost avoidance process involving SMBR and Supplement A applciations by unqualitfied individuals.
Records details of the accident, including referral, injuries, correspondence, type of insurance, and the attorney and insurance company. Most of this information is populated automatically through external system interfaces. Sohema manages court visits, settlement amounts, and requests for archived records such as medical or financial records, and uses queues to track and manage correspondence, validation of case details, valuation of recoverable amounts, and requests for archived records.
A key component to the insurance modules in Sohema is its ability to tracks the financial aspects of a recovery case. The financial modules that help support the insurance case management include:
- Claims orders
- Recoverable amounts
- Financial transactions, including payments, payment allocation, deposits, and transmittals
- Bulk items
- System amounts, including no-bill periods and overpayment amounts