LETTER/
FORMS
FORMS
A type of letter we are sending to the member after a claim has been process and adjudication has been done.
Explanation of Benefits
This tool can be referenced for claims involving older plans or as a back-up if DEBUT is not available.
Benefit Grids
The mentor document for CAS screen functions and identifications.
CAS Screen Lists
CAS
Claims Administration Sytem
A standardized five-digit numbers used by health care professionals to document and report medical, surgical, and diagnostic services and procedures
CPT codes
A type of letter we are sending to the provider after the processing the claim.
Explanation of Remittance (EOR)
A tool where we can see the electronics claims transmitted to humana.
Outlines the stages for reviewing a claim's status and details
Identify Claim Status and Details
MHI
Member hi
Defines the setting of where a service was provided
Place of treatment codes
A form or digital document you fill out to get back money you spent out of pocket for approved medical services from an authorized provider
Reimbursement Claim Form
Which CRM Plan Member link will you access to verify the remaining amount of a member's annual deductible
Accumulators
A mentor for reviewing the claim submission information
Member Medical Claim Submission Overview
CRU
Claims Research Unit
A standard letter-and-number code that tells humana what disease, injury, or symptom a patient has.
Diagnosis Code (IDC-10)
A form used by physicians and other healthcare providers for reimbursement of medical and diagnostic services
CMS-1500 form
A tool we use to review the realtime claims being processed on the member's plan.
HODMOD / CAS
Used to check the participating network of a specific provider from information found in MHI screen in CAS.
Participating Provider Codes (PAR Codes or PPCs)
Special Investigation Unit
A standardized set of alphanumeric codes used in medical billing to process insurance claims for healthcare procedures, equipment, and supplies.
HCPCS code (Healthcare Common Procedure Coding System)
A form that is used by hospitals and facilities for reimbursement of inpatient charge
UB-04 Form
A tool we use to view the paper claims submitted to Humana.
Humana Image Viewing System (HIVS)
A mentor document we can find the latest updates of humana-medicare information for any processes within Humana
Medicare Hot Topics
PARE
Pathologist, Anesthesiologist, Radiologist and Emergency Room Services
A four-digit number used on institutional medical bills (like a hospital claim form) to show the specific department or type of service that provided care