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IN Overview Doc

100

These are the plan names ____ Medicaid only, and _____ is the Integrated name.

Indiana PathWays for Aging, Humana PathWays Dual Care

200

This is the Humana Medicare Integrated Plan Contract Number for IN 2026 

H4939-001

300

Members coming to Humana from another plan must select an in-network provider within ____days of enrollment.

90 days

400

Members have to use in network providers with the following exceptions: List them all 

• • Family planning services, as long as the provider accepts Medicaid assignment.
• • Emergency or urgently needed care.
• • Medical care that Medicare requires our plan to cover, and the providers in our network cannot provide that care.
• • Kidney dialysis services received at a Medicare certified dialysis facility when the member is temporarily out of the service area

500

A Patient Liability is for ____, while the Waiver Liability is for _____.

SNF-Skilled Nursing Facility, HCBS-Home and Community Based Services

The System

100

You go to this system to see if a provider is in netowork

Find Care

200

Utilize this system to send activities to the CC

Guiding Care

300

If a provider submitted a claim electronically, but you cant find it in CRM, you would use this system to see if there was any rejects.

eHub

400

Use this system to see a paper copy of a claim

HIVS-Humana Image View Station

500

Use this system to see if the provider sent in some records

MRM-Medical Records Management

Whats the Humana Jargon?

100

CRM

Customer Relationship Management

200

ARI

Associate Remittance Inquiry

300

PAAG

Provider at a Glance

400

CRU

Claims Rework Unit

500

TAT

Turn around time

My Friend Mentor

100

This is your State specific document, full name

Indiana PathWays for Aging Overview CCC Provider

200

This will assist you on how to route your cases when you need to transfer them.

Case Routing CCC Provider

300

This document is helpful to always have open to give more in depth information regarding claim denials, pends and processes

Ex Code Guide CCC Provider

400

If a provider wanted to appeal I would open this document 

Provider Complaints and Disputes Indiana PathWays for Aging CCC Provider.

500

If a provider states they are missing their payment what document are you going to open

Provider Missing Their Payment CCC Provider

CAS Screen Use

100

This screen displays COB information for a member

CRI

200

This screen displays accumulation history for a member

MAI

300

I would use this screen if I wanted to find a claim by month and year for a member

MDI

400

This screen displays all contracts for the provider

CSI

500

You could use this screen to search by providers that share a TIN

PAI