Team Juan
These are ways on submitting claims
What is paper (mail) & Electronic
2 systems used for processing claims
What is CRM & CAS
received by member and provider to notify the outcome of the claim
Notification to an insurance company that payment of an amount is due under the terms of the policy plan
What is Claim
3 possible outcomes in processing claims
What is Paid, Pended & Denied
Identifies claims submitted from the hospital and facility. It's a uniform bill form used for billing hospital or facility fees
What is UB-04
It is the transformation of medical records into a format used in healthcare.
What is Claim Codes
This is the correct payer ID used for non-encounter claims, all medical Humana claims
What is 61101
This code represents the nature of illness or injury.
What is Diagnosis Code
Identifies claims submitted from the doctor or other healthcare provider for medical services provided.
What is CMS-1500
This is submitted when a true correction is needed.
This is a way of documenting claims details in CRM case without manually typing everything
What is Logging
This is the page in CRM where advocates can view the history of claims of a member
What is Claim Summary page
This tool is used to validate the member's responsibility in claim
What is Debut
This is a page in CRM where advocates can view the specific details of a claim including explanation, adjustments, POT, breakdown of amount.
This is claim detail page
This Quicklink in CRM is used to view the electronically submitted claims
What is Claim Image
This application/tool is used in viewing claims or other correspondence sent by members or providers to Humana via mail/paper.
This is Humana Image View Station (HIVS)
This is the difference between Billed and allowed amount
What is Discount amount
This is the contracted and the maximum amount that is going to be covered by the insurance
What is Allowed amount
These claims are sent when there is an update or change with claim outcomes or payment.
This is the copay, coinsurance or deductible that member pays on a claim
What is Member Responsibility
These codes represent the setting of the treatment
What is Place of service or treatment (POT/POS)
These can be obtained by some H1036 eligible members
What is Free OTC Items from Medicaid
This people manually process the claims when utilizing mentor
What is Claim specialist/Claim Adjuster
This code from PAAG is used to validate if provider is not just INN with Humana but also with the member's plan
What is Network Code