Team Juan
Kakarot
Team Piol
Team-ang
Team Aris
100

These are ways on submitting claims

What is paper (mail) & Electronic

100

2 systems used for processing claims

What is CRM & CAS

100

received by member and provider to notify the outcome of the claim

What is EOB & EOR
100

Notification to an insurance company that payment of an amount is due under the terms of the policy plan

What is Claim

100

3 possible outcomes in processing claims

What is Paid, Pended & Denied

200

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

200

It is the transformation of medical records into a format used in healthcare.

What is Claim Codes

200

This is the correct payer ID used for non-encounter claims, all medical Humana claims

What is 61101

200

This code represents the nature of illness or injury.

What is Diagnosis Code

200

Identifies claims submitted from the doctor or other healthcare provider for medical services provided.

What is CMS-1500

300

This is submitted when a true correction is needed.

What is Corrected claim
300

This is a way of documenting claims details in CRM case without manually typing everything

What is Logging

300

This is the page in CRM where advocates can view the history of claims of a member

What is Claim Summary page

300

This tool is used to validate the member's responsibility in claim

What is Debut

300

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

400

This Quicklink in CRM is used to view the electronically submitted claims

What is Claim Image

400

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)

400

This is the difference between Billed and allowed amount

What is Discount amount

400

This is the contracted and the maximum amount that is going to be covered by the insurance 

What is Allowed amount

400

These claims are sent when there is an update or change with claim outcomes or payment.

What is Adjusted claim
500

This is the copay, coinsurance or deductible that member pays on a claim

What is Member Responsibility

500

These codes represent the setting of the treatment

What is Place of service or treatment (POT/POS)

500

These can be obtained by some H1036 eligible members

What is Free OTC Items from Medicaid

500

This people manually process the claims when utilizing mentor

What is Claim specialist/Claim Adjuster

500

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

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