All About Medicare
Original Medicare offers _________.
Part A and Part B.
This list is used when a claim is over 60 days old, not in any InsPro queue, and still has not been processed.
Claims to Process List (360)
Other term for Medicare Supplements.
MedSupp or MediGap.
The date your policy coverage begins, and we start to cover claims.
Effective Date
Are claims that are resubmitted to Medicare by the provider, for a change in a service line amount, procedure code or diagnosis code.
Adjustments
Part C Medicare covers...
+200 if able to provide specific benefits.
Medicare Advantage
Dental, Vision, and Hearing
A claim denied after a policy reinstatement with no lapse in coverage must be added to Claims to Process after this many days.
30 days
As of what year, every Medicare Supplement policy is required to follow federal and state laws designed to protect the policyholder and they must be clearly identified as “Medicare Supplement Insurance.”
1992
A formal request to an insurance company asking for a payment based on the terms of the insurance policy.
Claim
If an adjustment is received that does not change the amount payable from the original claim, the adjustment claim will be denied as what?
+100 if you can provide the code.
Adjustment Zero Payable (D01-045)
This is a benefit that can be added to Original Medicare but does not automatically come with Original Medicare.
Medicare Part D: Prescription Drug Coverage
Claims in these statuses, starting with P06, cannot be discussed and cannot be added to Claims to Process.
Pre-rescind status/Medical Review
Plan that offers Part B Deductible.
Plans C, F, and F -HD
Copay required for Emergency Room (ER) visits under Medicare Supplement Plan N.
$50
If the amount payable has decreased by $25.00 or less, then it will be processed as a what?
write off
Medicare Annual Amount for Part A - Deductible for 2025.
$1,676.00
This MATRIX action must be selected before a CSR can submit a Claims to Process request.
Start Call?
2010 Plans that are only offered in select states.
Plans C and D.
This benefit applies to claims for in-patient services days 1-60.
+100 if you can provide the amt that we cover for 2026.
Part A Deductible
$1736.
T/F. When we receive a refund, a new claim will be created. On a refund claim, the ICN number will be an Aetna Claim Number so that we have a reference to which claim we collected the refund on.
True.
A person has two choices on how they get Medicare coverage, what are these two?
Original Medicare, or Medicare Advantage (Part C).
When submitting a claim to Claims to Process list, the CSR may enter the claim number—or one of these three alternative identifiers.
PLHS, DCN, or IFAX.
These policies are regulated solely by individual states
Pre-standardized Plans
Anyone who joins Medicare for the first time after 1/1/2020 cannot have these three plans.
+100 if you can provide what benefit these 3 plans cover.
Plans C, F, and High Deductible F
Part B Deductible
If the amount payable has decreased by over __________, it is considered an overpayment and we will be requesting a refund from the provider.
$25