Claim Essentials
Based on your memory: What is the lifecycle of a claim?
0.0
Based on mentor: what are the seven stages for reviewing a claim's status and detail?
Identify claims status and details.
Based on mentor: What are the 4 claim forms?
CMS 1500, electronic, superbill, UB-04
based on mentor: Can a member receive different bills for the same hospital visit?
YES, Claims determination overview.
Based on mentor: what is the general description, EOB message and EOR message for deny code 0/1
General: DX not valid for gender
EOB: The service rendered for this prodecure are not considered medically appropriate for this type of condition
EOR: Same as EOB message
Based on mentor: What can you tell me about the importance of medicare assigment?
0.0
Based on mentor: what is proc cd 71271?
Computed tomography, thorax, low dose for lung cancer screening without contrast material.
based on mentor: what type of information do we need on a reimbursement claim that is Domestic?
Member ID, Members name, providers name, provider TAX ID and NPI, Diagnostic codes, procedure codes, billed charges and dates of services, place of treatments, if applicable revenue codes, receipt or proof of payment.
Based on mentor: what is place of treatment CMS Code 81 CAS code: A
Independent lab
Based on mentor: what are the 2 ways members can get a reimbursement claims form?
Humana.com and send via emme ME2798