A standardized, paper insurance claim form that is used for mostly OUTPATIENT type services (DME, professional charges of providers)
What is CMS 1500, or HCFA 1500?
100
Centene Claims are adjudicated in this software platform.
What is AMISYS?
100
Check the member's "Eligibility Spans" to make sure they were a member of our health plan on THIS date.
What is Date of Service?
100
After locating the provider in CRM and clicking "Add Phone", click the Magnifying Glass icon in THIS field to locate the member which the provider wishes to discuss.
What is "REGARDING"
100
THIS is defined as a claim received by the Health Plan which requires no further information, adjustment, or alteration by the provider in order to be processed by the Health Plan.
What is a CLEAN CLAIM?
200
A unique ten-digit number that each provider will use when billing regardless of the insurance group s/he is billing to.
What is NPI?
200
THIS may include the amount paid, the benefits available, and reasons for denying payment.
What is Evidence of Payment or Explanation of Payment (EOP)?
200
Check the provider's "Affiliations" to make sure they were THIS on the date of service.
What is Participating (or in network)?
200
If the provider is calling to make a claims inquiry, document the call in CRM by clicking THIS button in the ribbon at the top of the window.
A standardized, paper insurance claim form that is used for mostly INPATIENT type services, hospital services, skilled nursing.
What is CMS 1450 or UB-04
300
This type of calendar is used to assign a date to every claim number based on the date the claim was received by the health plan.
What is Julian Calendar?
300
A service line may deny if a Procedure Code requires one of these other types of codes providing additional information regarding a service that was rendered.
What is a Modifier Code?
300
In Amisys, check numbers with a "9" in the 4th digit indicate that the claim was paid this way.
What is Electronic Payment or Electronic Fund Transfer (EFT)?
300
CetliCare Health and New Hampshire Healthy Families partner with ______________ for the delivery of Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA).
What is PaySpan?
400
A fraudulent type of overcoding that involves coding for services that are part of another service. The Correct Coding Initiative shows which of the codes are included in other codes.
What is Unbundled Services?
400
If a paper claim form can not be converted to electronic format because it is not legible, instead of being adjudicated (paid, pended or denied), it will instead be _____________.
What is REJECTED?
400
Service lines of a claim may deny if they were "carved out" of a globaled claim unless it was THIS type of service.
What are lab services?
400
In the Amisys provider "Address Inquiry" field, the letter "D" represents "Default Address", the letter "M" represents "Mailing Address" and the letter "F" represents THIS.
What is FINANCIAL ADDRESS?
400
Claims for services performed on or after 10/01/2015 must be compliant with this medical coding system created by the World Health Organization.
What is ICD-10?
500
A numerical classification that describes disease, injuries and causes of death.
What is Diagnosis Code?
500
Providers using an EDI Clearinghouse will need to provide their clearinghouse vendor with THIS code (HINT... Medical = 68069; Behavioral = 68068).
What is a Payor ID?
500
The provider may have neglected to put THIS in Box 23 of a CMS 1500 (red form) if you see a Denial Code of A1.
What is Prior Authorization?
500
In Amisys, when searching by name, THIS character should be used as a wildcard.
What is @?
500
Providers submitting Medicaid claims to NH Healthy Families will make best efforts to submit first time claims within ____________ days of the date of service.