Claims
This is the program used to store paper claims...
What is Tower?
This is the site used to check the status of a new Gold member.
What is the Gold Approval Screen?
This type of plan needs a Primary Care Physician (PCP) selected...
What is HMO?
Clicking on this requires you to document in CSI...
What is Create New Contact?
This type of appeal is for a non-covered service or non-covered provider...
What is an Organizational Determination (D2 OD)?
This is what CSI stands for...
What is Customer Service Interface?
The person who enrolls in the insurance plan...
What is the Subscriber?
This is the address to which both members and providers can submit paper claims...
What is :
GHP
PO Box 853910
Richardson, TX 75085-3910
Losing LIS, Moving OOA, & Aging in are all these...
What are Special Election Periods (SEPs)?
These 4 benefits are considered 'routine' by CMS and are traditionally non-covered.
What are : Dental, Vision, Hearing, & Fitness?
This application or tab would be used to search for a Provider in Facets.
What is Practitioner?
This is the company to whom a Discharge Too Soon Appeal must 1st be submitted...
What is Livanta?
LIS stands for this...
What is Low Income Subsidy?
A non-emergency situation when medical care is needed quickly...
What is Urgent Care?
This is the address to which a participating dental provider sends Dental claims...
What is :
Skygen address: PO BOX 512 Milwaukee, WI 53201
The effective date for those signing up during the Annual Enrollment Period (AEP)
What is 01/01/20xx?
The Preferred Enhanced is the only plan that has this benefit...
What is the Flex card?
This subsection in Facets is where you can view any system generated letters that were sent to members...
What is TCS Letters?
These 3 types of people are considered Legal Representatives...
What are POA, Legal Guardian, & Legal Rep of deceased mbr's estate?
LOB stands for this...
What is Line of Business?
This is the payment amount for services to which a provider agrees when contracting w/GHP and/or Medicare...
What is the Allowed Amount?
This is the code that tells you why a claim Paid/Denied...
What is the EX code?
This is the effective date of an SEP if there is nothing listed...
What is the 1st of the following month?
The Secure Rx is the only plan that has these 2 benefits...
What are the STAAR alert (Life alert) & Transportation benefits?
This is the shortcut for opening an application in Facets...
What is CTRL + O?
Not to be confused with an Authorized Representative, this type of person CAN file a complaint/grievance but the form is only valid for 1 year.
What is the Appointed Representative?
LEP stands for this...
What is Late Enrollment Penalty
This department handles member's insurances to determine who pays as primary, etc...
What is COB?
These are the What, Where, and Why codes...
What are the CPT (proc), Loc, & Dx codes?
Medicare created the Part D Enrollment rule in this year...
What is 2006?
These are waived if you are admitted as an Inpatient in the Hospital...
What are the Ambulance and Emergency Room (ER) copays?
These are the 'Wild Cards' in CSI and Facets when doing a search.
What are the * and % ?
These 3 types CANNOT file a complaint/grievance...
What are Medicare Sup mbr, Auth Rep, or provider?
Dc, Dx, Rx, & Tx stand for these terms...(in order)
What are Discharge, Diagnosis, Prescription, & Treatment?
This is when a provider tries to bill a member for the difference between what was billed, and what was paid, and is not allowed for Medicare Advantage members if the provider is par with CMS...
What is Balance Billing?
This code tells you if something about the Procedure code has been changed...
What is the Modifier Code?
This is the program that GHP uses to communicate plan changes with Medicare...
What is Marx?
These 5 plans have the OTC benefits...
What are the Classic Heritage, Classic 360, Secure Rx, Preferred Enhanced and Preferred 360?
The tab on the member's main page that allows you to see their Premiums, LIS, LEP, etc.
What is the Medicare tab?
A facility is required to provide a member with this at least 2 days before discharge...
What is the NOMNC?
HIPAA stands for this...
What is the Health Insurance Portability and Accountability Act?
This is the list, or book, of covered medications...
What is the formulary?
This is the number that identifies the provider on a claim and must be verified when a provider calls for member information...
What is the NPI?
This is the date by which GHP must receive the termination notice from the member to advise us that they are cancelling their enrollment w/GG...
What is : By end of business on the last day of the month they wish to term?
With noted exceptions, DME and Part B always have this...
What is a 20% coinsurance?
This is the prompt used to close and assign Appeals, LEP forms, & PBP forms, to make sure they are going to the appropriate departments...
What is Defect in Data?
In addition to filing a D2 when there is a dispute about a discharge date, regardless of hospital or SNF, this also must be done :
What is send a high priority Red Letter email?
NOMNC stands for this...
What is Notice of Medicare Non-Coverage?
This is medically necessary standard equipment that can withstand repeated use...
What is Durable Medical Equipment?