Claim Basic
Pharmacy / SNF/ Hospice / Hospital
What are facility services?
This is how to identify a reversal in CRM/Qnxt.
What are looking for the parenthesis or a minus sign?
The term for a member's enrollment information not matching in two or more systems is called?
What is an Eligibility Discrepancy/ Eligibility Discrepancies?
The title of the people able to call for eligibility status.
Who are members and providers?
These are all the lines of business covered by Molina.
What are Medicaid, Medicare, MMP and Marketplace?
The form for PCP/Specialist visits.
What is a CMS 1500 / HCFA 1500 form?
This is how Molina will cover an underpayment.
What is paying the difference only?
If eligibility is inactive in CRM what do we check next?
What is the corresponding state eligibility system?
This department handles potential members.
What is enrollment Growth?
This California plan name has part of the states name in it.
What is Medical?
This code is found on the UB04 claim form in box 42.
What are Revenue codes?
The department who handles any recoupments .
What is Cost recovery?
The turn around time for a member's account to be updated in South Carolina.
What is 24-48 hours?
When there is an eligibility Discrepancy for MP this person must reach out to the broker.
Who is the member?
This TX plan is for pregnant women who wouldn't normally qualify for Medicaid.
What is CHIP Prenate?
These codes are 3 to 7 digits long.
What are ICD 10 (Diagnosis) codes ?
This number is assigned to the member by the provider.
What is the Patient Account number?
The e-mail used to update eligibility discrepancies for WI.
What is WI_Enrollment@MolinaHealthcare.com?
The information you must verify with a provider before providing eligibility info.
What is:
NPI or TIN
Caller's name and providers name
Member's Name ID number and DOB or Last 4 of SSN
These two LOB's could cause members to share in their healthcare's financial responsibility.
What are Medicare and Marketplace?
This range of codes are for Labs and Pathology.
what are the 80000 - 89999 codes?
This is Also known as an Remittance Advice.
What is an Explanation of Payment?
In MI, if a discrepancy is regarding member's information such as gender, they reach out to this place at this e-mail.
What is the state at EnrollmentServices-Michigan@MolinaHealthcare.com?
For TX, the member must contact this agency if they are not eligible in Maximus.
What is the Health and Human Services Commission?
These are the three Plan names for WA.
What are Apple health, FIMC, and BHSO