What the OI
Insurance plan responsible for paying first.
What is primary?
A group of providers that Humana has chosen to provide care to members.
What is a network?
Pare represents this.
Pathology, Anesthesiology, Radiology and ER physicians.
Log this many claims when sending to CRU.
What is one claim per case?
QMB stands for this.
What is Qualified Medicare Beneficiary.
Humana verifies OI these three ways.
What are outbound calls, notification letters, and incoming calls.
This is the area of medicine a provider focus on.
What is a specialty?
This provider has an agreement with Humana.
What is INN/PAR provider?
This field on MHI represents if the provider is Par or Non-Par.
What is the PR field?
Qualified member who is protected from having to pay copay or coinsurance.
What is cost share protected.
This is completed to update OI.
What is the COB template?
This screen in CAS allows you to search for a provider based off of name only.
What is IPI?
This system is used to locate providers within a certain radius.
What is PFP?
This is created if a member lost the original EOB.
What is a duplicate EOB Request?
Member has this frame to restore the required level of Medicaid eligibility.
What is 6 months?
This screen in CAS is used to verify medical OI.
What is the CRI Screen?
This system is used to verify admitting privileges.
What is PAAG?
In addition to providing benefits, this must be verified as well.
What is needed an auth/referral on file?
This must be on file before a PARE claim can process.
What is a hospital claim?
The four basic eligibility criteria.
What are be eligible for Part A and B, have a qualifying level of Medicaid, live in service area and cannot have ESRD.
What is CRI,Member #,,First Name,Relationship
**Daily Double**Locate Megan Temp in PAAG and provide the billing address for the Medicare PPO.
What is PO BOX 1866 Green bay, WI 54305.
These questions must be asked when verifying benefits.
What is who, what, when, where and why?
This is out of scope for PAF.
What are skilled nursing, home health and G&A issues?
Designator that will help identify cost share protected members in Alabama and Florida.
What is BSN?