Back to Basics
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?
This CAS screen displays the provider's information, including address, tax ID, NPI, Line(s) of Business (LOB).
What is the PDI screen?
What plan type requires authorizations prior to services being rendered?
What is HMO?
This CI Screen shows the current and former PCP of a given member.
What is the PAMG screen?
The doctor or other provider you see first for most health problems.
What is your PCP?
This part is known as hospital insurance and does not carry a premium.
What is Medicare Part A?
This MHI modifier gives a list of the procedure code modifiers for CPT and HCPCS.
What is MOD?
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)?
What is the UMID screen?
The portion of the covered member's health care expenses that must be paid out of pocket before the member's plan begins paying its share.
What is the deductible?
This part is also known as your Medical Insurance
What is Part B?
This CAS screen houses SIU, Hospice and certain claim processing information
***Double Points!***
What is the CWI Screen?
This process should be used when a member or AOR is appealing for reimbursement of services already received.
What is Direct Member Reimbursement?
This screen is used when searching enrollment history in CI.
What is PAAL?
This is the total dollar amount submitted by a provider, as their fee for the services or supplies rendered to the patient.
What is the total billed charges?
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?
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?
This EOC should be submitted when an appeal is received in 2025 for a 2024 DOS.
What is the 2024 EOC?
This screen is used to show Alt. Format, DOB, DOD, and address
What is PEDM?
Approval in advance to get services or certain drugs
What is a prior authorization?
If a member has Traditional Medicare, but wants extra coverage for the 20% not covered.
What is a Medicare Supplement (Med Supp) plan?
This modifier in CAS indicates the NPI for the provider used to process the claim.
What is the NPI modifier?
This date is used as the Humana Received Date for the new appeal when Humana has vacated a previous dismissal.
This CI screen houses the plan type, and full contract number/PBP
What is the IPBD Screen?
Something you do if you disagree with the Plan's decision to deny a request for coverage of health care services or payment for services you already received.
What is an Appeal?