CRM
Rachel from Medical Group calls about a member, Linda. You are ____ the provider, and _____ Linda.
What is INTERACTING WITH the provider, and INTERACTING ABOUT Linda.
To authenticate a provider's authority to receive information about a member, we have to get two pieces of information from them. Name two pieces of information needed to authenticate the provider.
What are the TAX ID/NPI NUMBER and PROVIDER/FACILITY NAME
This is the CAS screen used to locate a member by name
What is the ASI screen
When it comes to coordinating benefits with other insurers, Medicaid is always:
What is SECONDARY to other insurers
A provider calls on two different members. Both issues need to be transferred to CRU. What is true regarding how to send to CRU?
Two case should be sent to CRU, one for each member
This is the page or screen that must be displayed to associate the information you've entered in QuickStart+ to the member's policy.
What is the PLAN MEMBER PAGE
This information is required per Humana's standard greeting
What is: THANK YOU FOR CALLING HUMANA and YOUR NAME
To locate all members with first name of Clint and last name Johnson in Kentucky, this is the control line that should be used.
What is: ASI,Johnson,C,KY
A person who qualifies for both Medicare and Medicaid is considered:
DUAL ELIGIBLE
In order for PARE logic to apply, the in-network hospital claim must be processed _______ in order to apply the correct PARE processing to the physicians claim.
FIRST
This is the name of the screen that displays all of the members active and terminated policies with Humana.
What is the PERSON ACCOUNT?
This is what must be done when placing someone on hold.
What is: ASK FOR PERMISSION, WAIT FOR A RESPONSE, PROVIDE ESTIMATED HOLD TIME, AND CHECK BACK IN WHEN HOLD TIME IS LONGER THAN COMMUNICATED
This is the CAS screen used to look up member information when you have the member ID
What is the MRI screen
A provider that participates with Medicare cannot charge more than what Medicare approves. This is also known as:
What is USUAL AND CUSTOMARY
If a provider is participating with Humana and does not submit the claim within the timely filing limits, then the provider _____________________________________ (fill in the blank)
HAS TO WRITE OFF THE CHARGE AND CANNOT BILL THE MEMBER FOR THE SERVICE
MER, PPO, MRO, MGP, MCD - are examples of this in CRM.
What is the PRODUCT TYPE
this is the system used to find a provider in the member's network that can be used by Humana advocates, providers, and members.
What is FIND CARE
A term date of all 9’s indicates the member is ________.
What is ACTIVE
Members coming to Humana from another plan must select an in-network provider within this time frame for Indiana Continuity of Care
What is 90 days of enrollment
A provider wants to know what Local Coverage Determination (LCD) applied to each line of the claim; this system is used to see the LCD that applied to the claim:
What is CAS
This is the full name of CRM.
What is CUSTOMER RELATIONSHIP MANAGEMENT
This is an internal transfer to the receiving party and releasing the call upon connection without an introduction of the caller is known as:
What is a COLD/BLIND transfer
"Y" in the ADPY field indicates this:
What is "an adjustment is made or a claim is reprocessed."
This is the contract number for the Indiana Integrated benefit Grid
What is H4939-001
This is the average turnaround timeframe when sending a claim inquiry or other investigation to CRU:
What is 14-30 days