Contracting
Contract Auditing includes
Who outlines the specific criteria for credentialing?
The State and NCQA- National Committee for Quality Assurance.
What are the 2 ways to access Mentor?
Through the My Apps, or Go/Mentor
Contracting documents
APEX or PAAG
What happens during Humana Provider Onboarding?
The Market provides specific Humana information to guide the Provider on Humana's processes and Procedures
What are the different cycles within the credentialing process?
Initial, re-credentialing, and de-credentialing
How do you have to search for your DX code if its longer that 3 characters?
Add a decimal
Processed claim information
CAS- Claims Administrative System
What does Onboarding usually consists of?
What could cause a Provider to lose their Credentialing status?
Malpractice, receiving clinical or financial sanctions and missing required re-credentialing information
What must be added to a revenue code to locate its description?
Leading Zero
Cases/Tasks from different Humana teams
CRM
Who manages Humana Contracts after Provider Onboarding?
Network Operations Coordinators NOCs
Describe Delegated credentialing
When Humana accepts a provider's credentialing status from an external entity, Humana does not perform the credentialing review but deems the provider participating per the delegates verification of the Provider's credentials.
What kind of documents does Mentor House?
Policies, processes, procedures, and code information.
What would require an amendment to a contract?
Once credentialing is complete- a Provider is considered BLANK and can receive payment for Humana members.
In-Network/ Participating
How can you save an excel spreadsheet to your mentor favorites?
Search by name for the resource, select the I Want to drop down, select Save to Favorites, Choose/Create the Folder to save to.
Important Internal Humana resources, processes, spreadsheets etc.
Mentor