Basic Statusing
This is a website where providers can log in and gain claim information.
What is a portal?
This is a phone number a member can call to update their coordination of benefits.
What is the Member Services number?
This term refers to the fixed amount a patient pays for a covered service.
What is a Coinsurance?
This type of claim is submitted when a correction needs to be made to a previously processed claim.
What is a revised or corrected claim?
When a claim is denied, providers or patients can file this request to have the decision reviewed.
What is an appeal?
This is a form of communication that needs to be looked at on CMD prior to statusing a claim.
What is the previous note?
This unique number identifies the member's policy.
What is a Member ID?
This is the amount a policyholder must pay out-of-pocket before insurance covers behavioral health services.
What is a deductible?
This process allows a provider to confirm if a service will be covered before treatment begins.
What is prior authorization?
If a patient exceeds their insurance plan's limit for therapy sessions, the claim may be denied due to this reason.
What is service limit exceeded?
This document, sent by the insurance company, provides details on how a claim was processed, including payments and denials.
What is an Explanation of Benefits (EOB)?
This type of policy allows members to get services rendered from an out of network provider.
What is a PPO?
A healthcare provider who is not contracted with a patient's insurance plan is considered this.
What is an out-of-network provider?
This unique identifier is assigned to each insurance claim submitted by a provider for tracking purposes.
What is a claim number?
This term refers to a claim that was submitted with errors and must be corrected before processing.
What is a rejected claim?
When checking claim status, providers should confirm if payment was sent via these two common methods.
What are electronic funds transfer (EFT) or a paper check?
Some insurance plans place this type of restriction on the number of therapy or counseling sessions a patient can receive per year.
What is a session limit or maximum visits?
If an individual loses their job, they may be able to keep their health insurance for a limited time under this federal law.
What is COBRA (Consolidated Omnibus Budget Reconciliation Act)?
Insurance companies use this three-letter acronym to refer to a claim that has been denied, requiring additional documentation.
What is an EOB (Explanation of Benefits)?
If an insurance plan deems a treatment unnecessary or not proven effective, they may deny it for this reason.
What is lack of medical necessity?
This insurance department handles inquiries about claims that have been submitted for processing.
What is provider services or claims department?
The name for a company that is used by a payer to provide specific coverage in a plan
What is a carve-out?
If a patient has two insurance policies, a provider must verify which plan pays first, a process known as this.
What is coordination of benefits (COB)?
If an insurance company delays payment on a claim, the provider may submit this type of request to prompt processing.
What is a claim status inquiry?
A behavioral health claim might be denied if it lacks this critical piece of information, often assigned by a licensed provider.
What is a diagnosis code?