CLAIM ESSENTIALS
An invoice (or bill) submitted to Humana by the doctor's office, hospital, or facility after a member receives medical care
What is a claim?
CRI screen that indicates whether a member has other health insurance coverage. This is where you'll find the other carrier details.
what is Coordination of Benefits Inquiry
are accessible in CRM via the Accumulators link on the Plan Member page
What is benefit Accumulations?
This screen is accessed by clicking the CAS Claim Prefill shortcut link on the CRM Claim Details page.
Medical History Inquiry (MHI) screen
Information a caller may request when checking the status of a Humana claim .
What are claim status calls?
helps support the Contact Center by researching and reprocessing claims
what is Claim Research Unit (CRU)
is a Medicaid program that covers the cost sharing for services provided by Medicare plans
Cost Share Protection (CSP)
_____ indicates where the medical service took place
The Place of Treatment (POT)
the timeframe a provider or member has to submit a claim to Humana for reimbursement.
What is timely filling or proof of loss?
The purpose of a______ is to distinguish between types of similar services or elaborate on the procedure performed
what is Modifiers?
__________screen in CAS displays a list of claims on file by claim number and provider name
The Multiple Claim Summary Inquiry (MDI)
Personal information/demographics supplied on a claim form.
what is member identifiers?
are three-digit alphanumeric codes used to determine the status and resolution of a claim
What are Explanation codes (EX)?
The shortcut path to CAS is through the _________link on the CRM Medical Benefits page
CAS Accumulators
The process used to ensure it contains the required information needed to determine the appropriate benefits available.
What is claim Adjudication?