Eligibility
The three enrollment periods
What are Open, Initial and Special?
The HMO products offered by Florida Blue
What are Blue Care, myBlue and SimplyBlue?
Any services or supplies provided by healthcare professionals, healthcare related companies and other organizations
What are benefits?
Form used by physicians and suppliers to bill for professional health related services.
What is the CMS-1500 Claim Form?
This is the system that authenticates members before populating their information in CustomerConnect.
What is the IVR?
This type of coverage is for all employees of the same company who purchase insurance together?
What is Group Coverage?
The products offered by Florida Blue that are not HMO
What are BlueChoice, BlueOptions and BlueSelect?
Costs that are due by the member after treatment occurs and is paid as a co-payment, deductible or coinsurance
What are post-service costs?
Form used by institutional providers to bill for health-related services rendered at a facility
What is the UB-04 Claim Form?
This type of search is required when the member was not authenticated through the IVR.
What is a manual search?
Online site set up as part of the Affordable Care Act that enables individuals to comparison shop for health insurance
What is the Exchange?
The Florida Blue product that has only coinsurance accumulating towards OOP maximum
What is BlueChoice?
An amount due at the time of the inpatient admission to a facility.
What is per-admission deductible?
Form used by members to request reimbursement for medical expenses they incurred.
What is the Medical (Subscriber) Claim Form?
This section of the Home Screen shows the member's name, ID number and plan name.
This date may differ among members on the contract
What is the eligibility date?
This product can be found in PIMS by locating the acronym MBN
What is myBlue?
A group that is composed of physicians, suppliers and facilities that have agreed to Florida Blue's reimbursement allowances
What is a provider network?
Consolidated health statement that provides claim-related EOBs for all finalized health and pharmacy claims.
What is the Member Health Statement?
This section of the Home Screen shows the member's demographic information.
What is the Member Card?
Refers to whether or not a member is entitled to receive benefits under the health insurance policy
What is eligibility?
A national program that enables members of one Blue Plan to obtain healthcare services while traveling or living in another Blue Plan's service area
What is BlueCard?
Services rendered without admission to the hospital for a stay that is less than 23 hours.
What are outpatient services?
What are sensitive codes?
This section of the Home Screen shows the same icons as the Node Ring.
What is the Side Menu?