Long-Term Care Insurance Facility Claim Form

Streamline Your Long-Term Care Insurance Claims

Filing long-term care insurance claims for facility-based care can be complex, involving multiple stakeholders including families, care facilities, physicians, and insurance providers. This Long-Term Care Insurance Facility Claim Form template simplifies the entire submission process by consolidating all necessary information—from policyholder details and care plan specifics to daily benefit calculations and medical necessity certifications—into one professional, easy-to-complete form.

Built for Healthcare Providers, Families, and Insurance Professionals

Whether you're a care facility administrator submitting claims on behalf of residents, a family member coordinating parent or spouse care, or an insurance agent helping clients navigate the claims process, this template ensures nothing falls through the cracks. It captures facility license verification, detailed care plan information, physician certifications, and accurate daily benefit calculations in a structured format that insurance carriers expect.

Smart Calculations and Conditional Logic

Paperform's built-in calculation engine automatically computes daily benefit amounts, prorates costs based on admission dates, and calculates total claim amounts—eliminating manual math errors that can delay claim processing. Conditional fields appear only when relevant, creating a streamlined experience that adapts to different claim scenarios.

Secure, Compliant, and Integration-Ready

With SOC 2 Type II compliance and secure data handling, this form meets the privacy standards required for sensitive healthcare and insurance information. Connect it to your practice management system, CRM, or document storage through Paperform's native integrations or use Stepper (stepper.io) to automate follow-up workflows like sending confirmation emails, routing claims to adjusters, or updating claim tracking spreadsheets.

Enhance with Papersign for Complete Documentation

Need physician signatures or facility administrator attestations? Use Papersign (papersign.com) to automatically generate signature-ready documents from form submissions, creating a complete, auditable claim package that accelerates approval timelines.

Perfect for assisted living facilities, nursing homes, memory care units, insurance agencies, and healthcare administrators managing long-term care claims efficiently and professionally.