CAMS
What is Coordinated Payment.
This program allows members to receive automatic refills of eligible maintenance medications.
What is automatic refill program.
residents may be eligible for revised auto insurance coverage beginning in 2020. Auto carriers may attempt to request a letter from the member regarding their health insurance coverage.
what is the Michigan Coverage letter
The subscriber or an enrolled dependent; term applies only while the person is enrolled under the policy
what is a covered person
The amount of eligible expenses the member must pay for covered health services per year before UnitedHealthcare begins paying for benefits
what is the Annual Deductible.
Employer funded account where employer sets the rules and decides the amounts.
What is an HRA
used when member is going on vacation and they want to fill their prescription early
what is a vacation override.
An electronic statement sent to member explaining services that were received
what is an EOB
Compare parents' birthdays to determine which plan is primary.
what is the Birthday Rule.
A serious medical condition or symptom resulting from injury, sickness, or mental illness that
- Arises suddenly
- In the judgment of a reasonable person, requires immediate care and treatment, generally received within 24 hours of onset to avoid jeopardy to life or health
what is an emergency
under this tab you can find the claim filing limit
what is general settings.
when a claim requires step therapy you will see this on rx claim
what is step therapy
An action that may result in unnecessary costs to the health care system. When a person or entity has not knowingly or purposely misrepresented facts but receives a payment that they have no legal reason to receive.
what is fraud abuse
This Type of plan we do not coordinate benefits with
what is medicaid
When you go to an inn hospital or surgery center and you have the following services Radiology, anesthesiology, pathology, and lab they will be covered as inn.
what is ROBLX
you would look here to find out whether the member has a card that is active or not.
what is purse enabled
A management program that guides members to preferred, clinically appropriate alternatives. Members must have tried low tier alternative prior to requesting a fill for the identified medication.
What is step therapy program.
the timeframe within which a claim must be submitted to a payer
what is timely filing
what is MMP
A service that enables new enrollees of UnitedHealthcare to receive time-limited care for specified medical conditions from a non-contracted physician at the benefit level associated with contracted physicians; payment is determined by the notification matching process
what is transition of care ( TOC )
extension of the plan year for dates of service to process under the members previous year’s spending account
What is a grace period
this pharmacy program allows for a $0 copay for medications
what is HCR
reduces the allowed amount on claim from certain OON providers when member's INN benefits are applied and a Shared Savings discount is not available
what is ENRP
This plan type has no network.
WHAT IS AN INDEMNITY PLAN
Amount of eligible expenses (stated as a set dollar amount) that the member must pay for certain covered health services - prior to and in addition to any annual deductible - before UnitedHealthcare begins paying for benefits for those covered health services
what is a per occurance deductible.