CAS
What is the meaning of the abbreviation CRU
CLAIMS REWORK UNIT
Which CAS screen do you navigate to see the specific month/year of a clam
the MDI screen
What is the platform you use to see the claim image, and where is it found?
EHUB which is located in My Apps
What is the name of the mentor document that is used to know where the member received care
Place of Treatment Codes
Claims processed within the last ______ are viewable in crm
24 Months.
There are three different CAS clients, what are they?
CAS CLIENT 56 - TX, AZ Markets
CAS CLIENT 57 - FL, GA Markets
CAS CLIENT 58 - All Other Markets
TRUE or FALES:
Benefit accumulations can carry over from one plan to another in the same plan year even if there is a gap in coverage
Benefit accumulations carry over from one plan to another in the same plan year ONLY WHEN there's no gap in coverage.
A member receives services from an out-of-network anesthesia provider at an in-network outpatient surgical facility. The claim is submitted on a CMS-1500 claim form. Will the claim be processed at the out-of-network benefit level because the provider is out of network?
No
Which screen in CAS tells you if the member claim was applied to the Deductible or maximum out of pocket
the MAI screen
True or False
Modifier D shows if the provider accept Medicare assignments, and Modifier CSP shows member copay or coinsurance.
Modifier D shows any deductible amount the member is responsible for.
Modifier CSP is used to verify the cost share protection indicator.
A member receives care from a provider who is not contracted with the health plan. Which of the following providers could still qualify the member for special in-network processing when all other requirements are met?
A. Cardiologist
B. Orthopedic Surgeon
C. Radiologist
D. Dermatologist
Answer: C. Radiologist
The special PARE provider types may qualify for in-network processing under certain circumstances:
What are the (6) most common screens used in CAS
Medical History Inquiry (MHI)
Multiple Claim Summary Inquiry (MDI)
Medicare Accum Inquiry (MAI)
Electronic Data Inquiry (EDI) screen
ESC Data Display Free Text (ETI) screen
ESC Line-Item Display (ELI) screen.