Back to Basics
CAS/CI
Post Service
Pre/Expy
Dismissals
100

This insurance is for people 65 or older. You may be able to get itearlier if you have a disability, End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant), or ALS (also called Lou Gehrig’s disease).

What is Medicare eligibility?

100

This CI Screen shows the current and former PCP of a given member.

What is the PAMG screen?

100

What plan type requires authorizations prior to services being rendered?

What is HMO?

100

This document is not required to be submitted with the case file if the appellant works for the doctor

What is an AOR?
100

When submitting a Dismissal in the portal, this is the Issue Category/Item Service Category used.

What is Appellant Dismissal Case File?

200

This part is known as hospital insurance and does not carry a premium.

What is Medicare Part A?

200

This CAS screen houses SIU, Hospice and certain claim processing information

What is the CWI Screen?

200

A WOL form is not required for appeals filed by these entities.

What is Department of Defense (DOD), Veteran's Affairs (VA), or Indian Health Services (IHS)?

200

This case priority gives IRT 24 hours from the MD decision OR 24 hours from the case due date (whichever comes first) to submit the appeal to the IRE.

What is an expedited appeal?

200

These are 3 examples of a dismissed appeal.

What is timely filing, AOR/POA not received, WOL not received?

300

This part is also known as your Medical Insurance

What is Part B?

300

This CI screen houses the plan type, and full contract number/PBP

What is the IPBD Screen?

300

This process should be used when a member or AOR is appealing for reimbursement of services already received.

What is Direct Member Reimbursement?

300
Appealing on behalf of a facility or DME company requires this document.

What is an AOR?

300

In this section of the ExRM UI, you see the original case#, original appeal type, original case status reason and requester information. 

What is Intake?

400

This type of Medicare coverage is purchased as a package with MA coverage and PDP coverage (MAPD) through a private insurance.

What is Part C?

400

This CAS screen is used for displaying accumulation history information for a member or plan for a particular month in a year.

What is the MAI Screen?

400

This EOC should be submitted when an appeal is received in 2024 for a 2023 DOS.

What is the 2023 EOC?

400

This type of appeal is chosen when a representative of the member calls with a verbal appeal and the member grants permission to speak with the representative on the phone.

What is a member appeal?

400

This is when the appellant disagrees with a dismissed appeal.

What is a vacate dismissal request? 

500

If a member has Traditional Medicare, but wants extra coverage for the 20% not covered. 

What is a Medicare Supplement (Med Supp) plan?

500

This modifier in CAS indicates the allowable per unit

What is the U modifier?

500

This date is used as the Humana Received Date for the new appeal when Humana has vacated a previous dismissal.

What is the vacate overturn letter date?
500

This is required to be completed/sent by the 72-hour mark when a case priority is changed from Expedited to Standard Pre-Service.

What is the Expedited Appeal Criteria Not Met letter?

500

These are 2 examples of why the IRE may overturn a dismissal.

The appellant has shown good cause

The MHP did not provide proof of diligent efforts when requesting AOR/POA/WOL

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