Claims Overall
What is the hyperlink you use to access the list of Claim History in CRM?
Claim Summary - Plan member page
Name the command you can use in any screen in CAS to go out to the main page.
byby
What is the command line for MHI?
- MHI,MEMBER ID,SUFFIX,FIST NAME, CLAIM NUMBER
- MHI,MEMBER ID,SUFFIX,FIST NAME, CLAIM NUMBER,MHI MODIFIER
What is a POD?
POD stands for Preferred Ophthalmology Doctor
If I went on September 1st 2024 to my PCP, Until when the provider can send the claim to Humana to be paid?
September 1st 2025
Where can you check what CAS Client to use to look for claims in CI?
CRM
- Plan Member
- Plan Information
- Platform
What is the modifier in MHI to look what will be the member responsibility?
L
True or False: H1036 can only see one Optometrist that should be assigned to them.
FALSE. They can only see their assigned Ophthalmologist but they can see different Optometrist
Name the code you will use to understand why a claim is denied.
EX code
What denial code is used to deny Hospice-Related services?
04D
What is the file where you can see when Humana process the claim?
PRDT
How are PODs Assigned?
They are assigned based on the member's PCP
How are Diagnosis Codes, Cause codes, and POT codes related?
They impact the payment of the claim and how it gets paid.
What will be the command line to check the claims filled for Jhon (H12345678) in July of 2023?
MDI,H12345678,,Jhon,EE,0723
They are identify by a numeric character
Where in mentor can you search what is the POD assigned using the member's provider ID?
H1036 POD Search
What are the four types of claims?
- CMS 1500
- Electronic
- SuperBill
- UB-04
What CAS screen will you visit to get all the information about DME claims?
DMI screen
What modifier would you use when checking the frequency of payment for a claim?
K