1
What are the six check statuses
Cleared
Cancelled
Outstanding
Stop Payment
Voided
Escheat
WHAT IS THE MEANING FOR THE ABBREVIATION PPI
Provider Payment Integrity
what is the meaning of TOB
TYPE OF BILL
WHERE DO WE GO TO VERIFY THE STATUS OF A CHECK
CHECK STATUS INQUIRY OR CAS
WHAT ARE THE FIVE W THAT ARE REQUIRED WHEN FILING OUT A CLAIM
WHO, WHAT, WHERE, WHEN, WHY
WHAT IS THE MEANING FOR THE ABBREVIATED WORD (HIVS)
Humana Image View Station
TRUE or FALSE humana advocate should tell members that their claims are in pending
False
IN THE MAI SCREEN WHAT DOES 01 AND 03 STAND FOR
01: COMBINED MAXIMUM OUT OF POCKET
03: IN NETWORK MAXIMUM OUT OF POCKET
WHAT IS ANOTHER WORD FOR TIME FILING
PROOF OF LOSS
Pamela called into humana wanting to know why her claim is denied. upon reviewing the claim you find the denial code 0$8, WHAT WOULD YOU INFORM TO PAMELA
hearing aid benefit exhausted
WHAT MODIFIER IS USED TO SEE IF PROVIDER ACCEPT MEDICARE ASSIGNMENT
MODIFIER A
WHAT ARE THE THREE PRIORITY STATUSES THAT YOU CAN SAVE YOUR CASE AS IN CRM
Normal, High, or Critical
Where in CRM can you find the Medical Policies Database... without searching for “Medical Policies Database”?
Accumulator quick link
WHAT DOES FREQUENCY CODE 7 STANDS FOR
CORRECTED CLAIM
what is the mentor document that tell you the different suffixes
Type Code Suffixes
Stop payment request are handled by which department
Provider Payment Integration
what mentor document can be used to confirm claim status
Identify Claim Status and Details
how Many clients do we have inCAS and their names
(3) 56,57,58
what is the mentor guide for EX and Cause codes
MTV and CAS EX Codes Guide
upon reviewing a claim in Cas the POT code shows I, where did the member receive treatment
Ambulatory Surgical Center
if the POT code in CAS shows 65, did Cas process it
End-stage kidney disease Treatment Facility
what is the cri screen used for
cri screen indicates whether a member has other health insurance coverage.
Senford Medical provided services on May 19, 2025, and billed $3,000. The claim was not submitted to Humana until July 9, 2026. The facility experienced an electrical fire in August 2025 that disrupted operations and damaged equipment.
NO IT DOES NOT MEET THE TIMELY FIIING EXCEPTION.
A provider billing office calls asking why they haven't received payment. You open the claim and see payee code "E." What's the clue hiding in plain sight, and what should you tell them?
Encounter claims are for services by primary care physicians or capitated specialists who accept a fixed monthly rate.
in cas what the EOB indicator AD stands for
IN NETWORK DEDUCTIBLE