Claim forms are provided in the “Welcome Packet” and may be downloaded from www.selmanco.com
If you are speaking to the "Insured" ask the caller to click on "Insured" scroll down to the claims section and click on "Claim Form"
Do the same for the providers, except the provider clicks on "Providers"
This claim form is for Hartford Supplemental policies.
This claim form is for Retail policies when the DOS (date of service) occurred during the first six months of a retail plan coverage. This form will be sent out by our claims department. You will have the ability to send duplicates of those forms to the insured if they request it.
CCF---COMPLETED CLAIMS FROMS. This is filled out by the insured. This allows Selmanco to do a pre-ex investigation. We can not perform the investigation unless we have this form back from the insured. They will list all doctors seen six months prior to the effective dated.
PMH--- previous medical history. This information is what the providers will send us once we have the ccf form from the insured
You can access these forms in your Tricare cheatsheet on your desktops. If the caller insured does not have access to email, and request the forms are mailed to the address on file.
You can send duplicate copies of these forms to the insured when they express that the forms have not been recieved.
The forms are located in the H drive (when Hartford is the carrier) or G drive (when Transamerica is the carrier).
When the insured request to have the CCF/PMH letter resent to them, there is a way for us to print them ourselves and send them. Please see below for instructions.
You would first have to find out which examiner sent the initial CCF/PMH form, for example Lisa Kegley. The examiner name will be in Emerge. Please click on the details button and read the notes.
1. You would need to go into the G drive, when the carrier is Transamerica OR H drive when the carrier is Hartford
2. Chose JMS Correspondence
3. If the policy is Hartford. Locate the oldest date we sent CCF/PMH. Open that folder and locate your patient's name. Create a new email, and attach all of your patient's documents and email it to them.
All emails must be placed in Imagenow. Leave detailed notes.
For Transamerica, locate the examiner initials (LK), then depress CNTL "F". this is a "find" option. Type in the last name of the insured.
**NOTE: if the insured has a common last name such as Jones, or Smith. Type in the first and last name and locate your insured.
If the insured has a unique last name you most likely won't need the first.
4. You would need to choose the insured person name, claim form will be listed next to the name. it would look something like this
LK Sarah Stewart claim form
5. Once you click on the information, it will bring up the PMH letter that was sent initially. Please be sure to print all of the letter we sent. There may be multiple, please look for all of them.