Claim GURUS
A CAS Claim has a EX CODE 04D on MHI screen which means Bill HFCA intermediary for Hospice services. To verify hospice effective dates, which CAS screen is used to locate eligibility dates? + 500
CWI
Which field of the CAS MHI screen identifies the place of treatment in CAS +800
T
which CAS screen are you directed to after clicking the CAS Claim prefill link in CRM? +500
MHI
Where is the claim summary link located in CRM? +500
PLAN MEMBER PAGE
TRUE OR FALSE: We can send the EOR to a member +18000
FALSE
Which CAS MHI field displays the date the claim was received? +5000
RDT
what is the name of the link on CRM claim details page that opens Humana image view station. It also allows users to view an image of a paper claim that was submitted by a provider.
Claim Image
What would you enter in the control line when accessing the EDI screen?
EDI and claim number
What does Payee Code E or I indicate? +400
The claim paid to a capitated agreement
How can we identify if a claim is in SIU review? +15000
pended claim description , CRm alert
Which are the primary outcomes of a claim in CAS
Paid , pended , denied
In CAS what does payee code R mean?
Deny line item to provider
MHI MODIFIER K: what does it display?
Check number in the Check# field and voucher codes in the VCH field , which shows a code on how the provider is going to be paid
what is the purpose of the ELI screen?+3000
display line item information such as date of service and diagnosis.
TRUE OR FALSE
Radiology can be considered as Home health care
FALSE
WRITE ON THE BOARD
What is the correct control line used to look up a list of claims for a specific date? +1000
MDI,#######,,firstname,ee,MM
If a CMS 1500 claim form contains a place of treatment code 31, which POT code will display on screen in CAS +500
8
What is the primary purpose of MHI is CAS
detailed claim history for member
TRUE OR FALSE : We can view medical and dental claims in CRM service
TRUE
TRUE OR FALSE
A adjustment is performed when the member's cost sharing is affected
TRUE
Which code is used to identify room and board services billed on a facility claim?
Revenue Code
Which code consists of a single letter followed by four digits and is also used on claims to identify supplies and non-physician services?
HCPCS
TRUE OR FASLE
Pathology and Laboratory are categories within CPT CODES
TRUE
what are the 3 types of provider ID's used to identify a provider? +1000
TIN CAS ID NPI
TRUE OR FALSE:
We can inform a member that an individual claim is under SIU? +250
FALSE : never inform