General
The team responsible for verifying coverage
What is the policy validation team?
A document that confirms payment was made by an insured
What is the proof of payment?
A task opened when there are duplicate claims
What is Policy Validation - Merge Claim task
A letter advising the claimant that we are unable to make payments for their expenses
What is a denial letter?
A tab on GoTrex (CCI or CWC) where you find the documents attached to a claim.
What is Documents Tab?
An itemized bill received from a US facility
What is a HCFA or UB?
A document required to validate the answers provided on a medical questionnaire and/or check for pre-existing conditions
What is a PMH or MHC?
A task to convey information to an assessor
What is claims assessment f/u task?
A letter advising the claimant that they have a deductible
What is a deductible request letter?
A final document sent to an insured by their insurance company explaining all the expenses paid and/or denied.
What is an EOB (or Explanation of benefit)?
The task opened when there is other insurance indicated
What is Recovery - Review Other Insurance Information task?
This communication contains the claim review information
What is a Case Summary note?
A document showing the Eligibility criteria, benefits, limitations and exclusions of policy
What is a policy wording?
A task used to request medical record
What is med review - send M/R request
A letter advising the claimant we are only paying a portion of their claimed expenses
What is a partial payment (decision) letter?
A document consisting of questions, which is used to determine policy eligibility and/or rate category
What is a medical Questionnaire?
A task used when we need to reissue a payment or trace a payment
What is Finance - Trace Payment task?