Billing
What is paid to a provider based on the HNE Contract
Allowed Amount
The screen I use in care to locate a member
Find
Reviews auth requests for DME ordered through a DME provider. You can find the auth response on my portal
Northwood
I am the system that lets you check benefit usage, eligibility, and additional claims information
Amisys
What we need on file to speak with someone other than the member
PHI
Your share of the cost for covered services calculated as a percentage of the allowed amount
Coinsurance
The purchased Rider that allows an HMO member 3 visits to certain Boston Facilities
Here to There
Medical imaging exams used to assist in diagnosis.
Radiology
Here you can view authorizations reviewed by HNE and the status, complaints and appeals, and the response letters
MHK
The Formulary a Be Healthy member uses
Mass Health Formulary
The amount you owe for services covered by your plan before your plan begins to pay
Deductible
Where in CARE I can see if a member has used their preventive visits?
The Counter
Any medically necessary activity used for determining the cause of an illness.
Diagnostic Service
This is where you check for authorizations for Injectable medications
Prime Therapeutics
Gives the provider a breakdown of how the claim was processed and the amount HNE is paying
EOP
What has to show on a claim in order for it to be considered completed?
A Paid Date
Where in CARE I can see the deductible that has been met for the current plan year
Enrollment/accumulator
The collection and processing of samples such as blood, urine, plasma, etc. in order to diagnose.
Labs
The system we use to check eligibility for a Mass Health member
Virtual Gateway
Who reviews new to market medications
HNE
Amount paid for a covered service in a geographic area based on what the OON Providers in the area usually charge for the same/similar service
Reasonable and Customary
Where can you find messages in CARE on whether a caller has PHI or who the division contacts are?
Remarks
I am the system where you can check for authorization requests and status of MRI CT and Pet scans
Evicore
I am the system that allows you to assist a member with the member portal
HNE Admin Portal
The department we send information to when there is Other Insurance coverage
COB