Claims
The first place we would look to pull up a claim for a member.
CRM
This is who is allowed to request a disenrollment for member?
Member or POA
Also known as CI
Customer Interface
A provider sends this with info, to Humana, to be paid for their services/request or payment of services.
a Claim
When a member cancels the plan BEFORE the effective date
Cancellation
Also known as CAS
Claims Administration System
This is the next step to a denied claim, if the member disagrees
Appeal
When member wants to cancel a plan AFTER the effective date
Disenrollment
Also known as LEP
Late Enrollment Penaltty
Once you research a claim, and find out it's been processed incorrectly, you would route your case to this team for review.
CRU
If CRM doesn't show the enrollment info because it hasn't been 72 hours, what system would we check next?
CI
Also known as CMS
Centers for Medicare and Medicaid Services
This is the document you would use for more info and next steps for claim denial codes
MTV and CAS Ex Codes Guide
You must have these parts of Medicare to have an MAPD plan.
Part A,B and D
Also known as MHI
Medical History Inquiry