Claims Basics
This is the process of determining how a healthcare claim should be paid.
What is claims adjudication?
This program primarily serves people age 65 and older.
What is Medicare?
EOB is the acronym for this document sent after claims are processed.
What is an Explanation of Benefits?
Before entering information into a public AI tool, you should ensure it does not contain confidential data or this type of member information.
What is PHI (Protected Health Information)?
This monthly game was recently played during a CCPD Weekly Huddle and featured categories such as World Cup, Fireworks, and a certain famous wizard.
What is Jeopardy?
A request submitted by a provider seeking payment for healthcare services.
What is a claim?
This program is jointly funded by federal and state governments.
What is Medicaid?
CMS stands for these four words.
What are Centers for Medicare & Medicaid Services?
The instructions provided to an AI system are called this.
What is a prompt?
This recognition program allows employees to acknowledge peers for demonstrating company values and making a difference.
What is Bravo!?
This document explains how a health plan processed a claim.
What is an Explanation of Benefits (EOB)?
Individuals eligible for both Medicare and Medicaid are often called this.
What are dual-eligible beneficiaries?
SDOH stands for this phrase related to factors affecting health outcomes.
What are Social Determinants of Health?
The use of technology to perform repetitive tasks with limited human intervention.
What is automation?
This annual recognition program honors UnitedHealthcare team members who make a difference for members, providers, customers, colleagues, and who consistently exceed expectations.
What is Service Heroes?
A claim that contains all required information and can be processed without additional documentation.
What is a clean claim?
This federal agency oversees both Medicare and Medicaid programs.
What is CMS (Centers for Medicare & Medicaid Services)?
HIPAA stands for this law protecting health information privacy.
What is the Health Insurance Portability and Accountability Act?
Responsible AI emphasizes fairness, accountability, transparency, and this concept.
What is safety?
This core value is demonstrated when teams work together to deepen connections and improve outcomes.
What is Relationships?
This term describes a claim that is not approved for payment as submitted.
What is a denied claim?
This type of organization contracts with states to administer Medicaid benefits for enrolled members.
What is a Managed Care Organization (MCO)?
CHIP stands for this children's healthcare program.
What is the Children's Health Insurance Program?
This type of AI creates new content such as text, images, or summaries.
What is Generative AI?
Successful CCPD projects often rely on this skill: bringing together people from different teams to achieve a common goal.
What is collaboration?