Process Questions
•Where do I go to pull data for an audit?
Live Files
What does POP stand for?
Percent of Premium
What is the SF product code for HMO POS?
MRO
Surplus only with no rewards is a cat code...?
Cat Code S
What system do we get our production tasks in?
Apex
•What starts the SF process to implement a new contract?
Grouper Request
What kind of contract does "PCP" following a CAS ID indicate?
Capitated Contract
What is the SF product code for PFFS?
MEF
What does "CSS" mean?
Contract Summary Sheet
How often do live files refresh?
Daily
•Who are your points of contact for assistance/questions in SF?
Your AD and/or Senior
What is PMPM?
Per member per month
What is the SF product code for HMO?
MER
First thing to check on a contract is?
If its executed/signed
N & 2 (Non-value Based)
•What date is CAP typically ran?
The 20th of each month
What does DOFR stand for?
Division of Financial Responsibility
What is the SF product code for LPPO?
MEP
What is the highest level of VB a provider can contract with Humana for?
Global or Cat Code G
What is the PCP load SLA?
In SF by the 10th complete by CAP run
•Does CAP run payments pay the previous, current, or following month?
Following month
What kind of contract does "FFS" following a CAS ID indicate?
Fee For Service Contract
What is the SF product code for Medicaid?
MCD
What type of contract 0 pays claims and gets paid a PMPM?
Capitated
What do we need to CYB for contract loading and contract updates?
Paper Trail/Documentation