All About MATRIX
Although CSRs cannot request this identifier, if a caller volunteers it, you may use it in MATRIX’s Advanced Search.
Social Security Number
This list is used when a claim is over 60 days old, not in any InsPro queue, and still has not been processed.
Claims to Process List (360)
Under what tab would you be able to see the information regarding the services rendered?
+100 if you can provide the header.
Payment - Service Line Summary
The date your policy coverage begins, and we start to cover claims.
Effective Date
Are claims that are resubmitted to Medicare by the provider, for a change in a service line amount, procedure code or diagnosis code.
Adjustments
On the Claim Summary screen, this date reflects when the information was sent to the payment vendor—not when the payment posted.
Disbursement Date
A claim denied after a policy reinstatement with no lapse in coverage must be added to Claims to Process after this many days.
30 days
If you want to see the EOB description, you would need to click on this.
Remark
A formal request to an insurance company asking for a payment based on the terms of the insurance policy.
Claim
If an adjustment is received that does not change the amount payable from the original claim, the adjustment claim will be denied as what?
+100 if you can provide the code.
Adjustment Zero Payable (D01-045)
Although viewable in MATRIX, provider EOBs cannot be sent to policyholders because they may contain this type of sensitive information.
+100 if provided the meaning instead of the acronym.
PHI (Protected Health Information)
Claims in these statuses, starting with P06, cannot be discussed and cannot be added to Claims to Process.
Pre-rescind status/Medical Review
Under what tab can you see the services that are covered by the plan the member have?
Plan Details
Copay required for Emergency Room (ER) visits under Medicare Supplement Plan N.
$50
If the amount payable has decreased by $25.00 or less, then it will be processed as a what?
write off
If MATRIX lists “Issue Age Med Supp,” the policy falls under this plan category.
Pre-standardized or 1992 standardized plans
This MATRIX action must be selected before a CSR can submit a Claims to Process request.
Start Call?
You can see the limits indicated for the benefits on this tab.
Claim Maximums.
This benefit applies to claims for in-patient services days 1-60.
+100 if you can provide the amt that we cover for 2026.
Part A Deductible
$1736.
T/F. When we receive a refund, a new claim will be created. On a refund claim, the ICN number will be an Aetna Claim Number so that we have a reference to which claim we collected the refund on.
True.
This claim source replaced EMDEONPAPER after February 22, 2024, automatically converting scanned paper into electronic files.
OTIAOCRBOT
When submitting a claim to Claims to Process list, the CSR may enter the claim number—or one of these three alternative identifiers.
PLHS, DCN, or IFAX.
If you want to check the codes exempted to the limiting charges, you would want to start by clicking this tab in InsPro.
Claims
Anyone who joins Medicare for the first time after 1/1/2020 cannot have these three plans.
+100 if you can provide what benefit these 3 plans cover.
Plans C, F, and High Deductible F
Part B Deductible
If the amount payable has decreased by over __________, it is considered an overpayment and we will be requesting a refund from the provider.
$25