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Medical Claims

Across
This is a fixed amount for which the mbr is responsible for
Once the mbr has paid this , Humana will pay 100% of all covered cost for the remainder of the year
The mbr must pay this before Humana will begin to cost share
This screen in cas is used to locate the raw line item information
This is a form of mbrsp when it is calculated at a percentage and not a fixed rate
This screen is accessed in cas to view the mbrs accumulation information
This is when a member has more than one insurance carrier.
This is the amount Medicare states they will allow for services
This system can be used to locate a providers contract information
This acronym is used in cas to find a specific claim
You can use these to locate a claim faster in crm
According to HIPAA guidelines , if the mbr or poa is not available , a ccs can speak with the representative as long as they have _____ pieces of information regarding that specific claim in question .
Down
This screen is used in cas to view the providers network numbers and contract dates
This acronym is used to describe the team that reviews claims with possible errors
Duplicate EOB's can be sent out using this system
Without this piece of information the providers office will not speak with you.
If a provider accepts this they can not balance bill the mbr
Providers must follow this rule when submitting claims for processing
This is the amount the provider would like to get paid
This is the provider write amount in crm claims detail page
The mbrs get a bigger discount when they use doctors within their ____.
This screen in cas is used when locating the provider specialty
If a member is unsure of the date of service. This screen in cas can be used