Claims Trained
When does a grace period take place? (+900 points)
When a D-SNP member loses full Medicaid coverage or the required level of Medicaid eligibility for the plan
Which tool should be used to quote DE-SNP plan benefits? (+1000 points)
DEBUT
Case Logging is the additional logging feature available on CRM Service that is used to log claim details to a case. True or False?
True
I can call this team for help with a claim. (+1500 points)
Phone-A-Friend (PAF)
I can use this tool to locate a check, its number, and to view the members who are being paid by the check. +10000
Associate Remittance Inquiry tool
What chronic conditions are CSNP plans designed to support? +400
Cardiovascular Disease CVD
Chronic Heart Failure CHF
Diabetes Mellitus DB or DM
Chronic Lung Disease CLD
Write It!
Write the cause codes of the following:
1. Illness
2. Outpatient Hospice
3. Diabetic services
ILL, HSPCO, DIAB
True or False:
Members have 18 months to restore the required level of Medicaid eligibility.
False, it's 6 months.
What is the payee code for HMO plans?
E
The form identifies claims submitted from the doctor or their healthcare provider for medical services. (+300 points)
CMS 1500
This Payee code identifies a suspense claim: Payer 2 or 5 (+4000 points)
T
What is the name of the screen in CI used to verify the status of a VCC form? (+500 points)
CSNP
True or False:
Advocates are able to send member's a VCC form?
True, it's through EMME.
What is this field on the MHI screen that indicates the amount of the charges paid as a basic medical benefit for the claim line items?
BASIC
How many stages are there on the research to understand the claim Mentor document? (+1500 points)
5
This CAS screen is used to verify Medicaid information like administrative state, cost share, and deeming status. What is it?
MEVH Screen
This field on the MEVH screen will indicate that the information has already been verified. What is it?
VFY CD
True or False:
A member with a DE-SNP plan should present only their Humana ID card at the time of service.
False. Members should present both their Humana ID card and their Medicaid ID card.
What does SIU do? (+2000 points)
It reviews and investigates activity involving claims, members, agents, groups, or facilities who are suspected of fraudulent activities.
What are the Local Coverage Determination EX code that apply to a member's responsibility? (+1500 points)
179 17B 17M
Write It!
This control line in CAS screen is used to display member/dependent information. (+2000 points)
MRI, UMID
MRI, SSN, Suffix, Modifier
What does the 908 end-reason code mean? (+1500 points)
This reflects the loss of the required Medicaid eligibility for the member's eligible SNP and terminates the Medicare Dual SNP enrollment.
True or False:
Claims are processed in the order they are received (+200 points).
False. Refer to the Claims Determination Overview Mentor document.
TANGO handles the claim determination for Medicare HMO & PPO members in which states? (+5000 points)
Arizona, Colorado, New Mexico
If Medicaid eligibility is terminated and the member has medical access to care issue, which team would transfer the CRM case? (+3000 points)
Special Needs Plans Validation Support