CLAIMS TRAINED
What CAS Client do we use for the states Florida and Georgia
57
What are the local coverage determination EX code that apply to a member's responsibility? + 1500
179 17B 17M
What does "SNP" mean? + 3500
Special Needs Plan
I can use this tool to locate a check but its number and to view the members who are being paid by the check. +10000
ARI TOOL
This column on the MEVH screen will indicate the information has been verified.
VFY CD
What are the Medicare and Medicaid requirements for dual eligibility status? | +600
•Eligible for Medicare Part A and B
•Must have a qualifying level of Medicaid assistance
•Must live in the Service Area
•Cannot have ESRD (except in special circumstances)
What is the payee code for HMO
E
How many months is the grace period for members to restore the required level of Medicaid eligibility?
6 months
The form identifies claims submitted from the doctor or their healthcare provider for medical services. +300
CMS 1500
What is the name of the screen in CI used to verify the status of a VCC form? +500
CSNP
They are the ones that review and investigate activity involving claims , members , agents a, groups , facilities who are suspected of fraudulent practices. | +500
SIU
This Payee code identifies a suspense claim: payer 2 or 5 +4000
T
If additional information is needed for a Duals Eligible member Benefits:Verification call, advocates are to use this tool.
DBCC Tool
(DSNP Benefit Coordination Crosswalk)
I can call this team for help with a claim. +1500
Phone a friend.
This field on the MHI screen indicates the amount of the charges paid as a basic medical benefit for the claim line items
BASIC
Which tool should be used to quote DE-SNP plan benefits? + 2000
DEBUT
What is the relationship code for member?
EE
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
How many stages are there on the research to understand the claim mentor document? + 1500
5
This screen is used to verify Medicaid information like administrative state, cost share , and deeming status?
MEVH Screen
WHAT ARE THE CAUSE CODES FOR THE FOLLOWING | + 3000
Illness
Outpatient Hospice
Diabetic services
ILL ,HSPCO ,DIAB
This End Reason Code reflects a loss of the required Medicaid eligibility for the member's eligible SNP and terminates the medicare dual SNP enrollment.
+1500
908
TANGO handles the Claim determination for Medicare HMO a PPO members in the following states +5000
ARIZONA
COLORADO
NEW MEXICO
What is the name of the jumplink in CRM in claim details page that opens Humana Image View Station or HIVS. This allows us to see an image view of the paper claim submitted by the provider. +3000
Claim Image
In MAI Screen, which 2 fields should have the same value for us to determine that the members accums are in sync? | +150
IND TOT and IND HIST