Terminologies
used to add information to improve the accuracy of a service provided. For example, LT or RT for left or right
Modifier
These plans have basic benefits and additional riders that the policyholder can choose from to customize their plan for an additional cost.
Non-Standardized Plans
are a legal part of a file and can be used in cases of DOI complaints or lawsuits
Notes/Memo
Three ways we receive claims.
By mail, fax or electronically.
When MATRIX first opens, you will have access to the following sections.
Search
Message Board
Tool Bar
The date claims will no longer be covered until the next premium is received.
Paid to Date
Plans that are offered as high deductible plans.
Plans F and G.
What is the meaning of CARC?
Claim Adjustment Reason Code
How long does it take for crossover claim to register?
It can take between 30-60 days.
Under Tool Bar,
This link will be used to add a claim to the Stop Pay Log or the Claims to Process list
To Department
The amount is determined by Medicare and is the responsibility of the insured. We will pay this amount if the policy covers it.
Deductible
All policies offer the same basic benefits, but some offer additional benefits so the policyholder can choose the plan that meets his or her needs
Standardized Plans
If you see D on the 'Type' column for CMS Crossover Information, this means __________.
Deleted
Once Aetna receives the claim, we have an average of __________ to process the claim.
30 days – 60 days
Three ways to search for policies under Matrix.
By Policyholder
By Agent
By Provider
Identifies the type of benefit being processed, based on the information submitted on a claim
Benefit Code
January 1st, 2020 brought new changes to the plans available for policyholders. This change is called what.
*Plus 200 if you can provide the meaning.
MACRA
This screen will display all the caps on the different benefits. This screen is very useful when checking if the High Deductible is met.
Maximums
A claim must be filed with Medicare no later than _______________ after the date of service.
12 months, or one calendar year
If a memo is left in InsPro, how long does it take to appear in Matrix?
It can take up to 24 hours to appear in matrix.
Changes that Medicare or the provider make to a processed claim.
Adjustment
What is the plan that has a special drug feature that covers certain prescription drugs.
1992 Plan J-Drug Benefit
The accept crossover information will open. __________ will display a status.
CWF Disposition
if something goes wrong and it does not crossover, the provider (or policyholder) has __________ from the Medicare process date to file the claim with the Medicare Supplement company, according to our policy.
15 months
MATRIX will store all claims from the last __________.
From the last 365 days.