BASIC CLAIM INFO
2 main types of claim form?
CMS-1500
UB-04
What's the control lines for the MRI screen
?
MRI,MEMBER ID/SSN
The Acronym CAS means?
Claims Administrative System
The acronym CRU stands for?
Claims Research unit?
How long does a claim takes to be processed?
45-60 days
What is a claim?
A request, made to an insurance for payments to be made based on services provided.
How do you identify a client the member uses?
CRM- PLAN MEMBER PAGE-PLAN INFOMATION-PLATFORM
To see claims for a specific month and year, or the entire year that was processed.
The CAS prefill tab in CRM takes us to what screen in CAS?
MHI
Besides physician finder, What system can be used to verify a Provider's status?
PAAG
How do you capture claim info in CRM?
Logging
What can be added to the MHI control line to view Additional information that wasn't initially displayed?
What information can be seen utilizing the DMI screen?
If a DME was rented or purchased?
Define Balance Billing.
The is the practice of providers billing for covered services over the insurer's allowed amount
Which mentor contains all claim related call handling procedure?
Claims Determination Overview
What type of information should NOT be discussed with a member?
Check information
Full control line for the MHI screen
?
MHI,MMID/SSN,SUFFIX,MEMBER'S NAME,RELATIONSHIP,CLAIM NUMBER(OPTIONAL)
The P field on the MHI screen indicates what?
Payee Code
What modifier allows you to see the primary specialty of a provider on a claim?
SPEC
What team handles the reprocessing of claims?
CRU
Define the SMARTEOB, and who receives it?
Breakdown of claims processing information for a member, only MEDSUP members will receive it.
What is the MAI screen used for?
To view Accumations information for a member.
What screen in CAS is used to view hospice claims?
CWI SCREEN
Define Timely Filing?
How long do providers have to submit a medical claim?
The is the duration in which a provider has to submit a claim for payments for services that would have been rendered.
1 calendar year
What is a Concurrent Authorization?
This occurs when changes or updates are required to an existing authorization for services currently being received.