General
This a tool on GoTrex, specifically made for assessors to assess claims
What is CWC (Claims work center)?
The team responsible for verifying coverage
What is the policy validation team?
A document that confirms payment was made by an insured
What is the proof of payment?
A task opened when there are duplicate claims
What is Policy Validation - Merge Claim task
A letter advising the claimant that we are unable to make payments for their expenses
What is a denial letter?
A tab on GoTrex (CCI or CWC) where you find the documents attached to a claim.
What is Documents Tab?
An outcome selected for the review claim for decision task when the claim is a denial
What is not payable/denied outcome?
A document required to validate the answers provided on a medical questionnaire and/or check for pre-existing conditions
What is a PMH or MHC?
A task to convey information to an assessor
What is claims assessment f/u task?
A letter advising the claimant that we have applied the deductible or to send the deductible
What is a deductible request letter?
The team responsible for triaging documents and creating bills
What is the Document Management team?
This is where we can see the diagnosis on a bill in e-rep
What is "Click to show diagnosis" button?
A final document sent to an insured by their insurance company explaining all the expenses paid and/or denied.
What is an EOB (or Explanation of benefit)?
The task opened when there is other insurance indicated
What is Recovery - Review Other Insurance Information task?
A letter advising the claimant that we cannot make the decision due to missing document(s)
What is the conditional denial (Missing info foreign claim) letter?
This communication contains the claim review information
What is a Case Summary note?
An itemized bill received from a doctor in the US
What is a HCFA (or Health Insurance Claim Form)?
A document showing the Eligibility criteria, benefits, limitations and exclusions of policy
What is a policy wording?
A task used to request medical record
What is med review - send M/R request
A letter advising the claimant we are only paying a portion of their claimed expenses
What is a partial payment (decision) letter?
An itemized bill received from a US facility
What is a UB?
A document consisting of questions, which is used to determine policy eligibility, rate category and premiums
What is a medical Questionnaire?
A task used when we need to reissue a payment or trace a payment
What is Finance - Trace Payment task?
A letter sent to the provider or claimant advising we have made a double payment
What is an overpayment letter?