Humana Systems
This is the system used to locate medical records.
What is medical records management?
This is the electronic payer id for medical claims including Medicare Supplement.
What is 61101?
This is the system used to search billing history of a procedure code. (Be Specific)
What is Procedure Code Search in DIG Toolbar?
This screen will display the accumulation history information for a member or plan by a specific month and year.
What is the MAI screen?
This CRM page has the member's demographic information including: address, DOB, gender, phone, email.
What is the PERSON ACCOUNT page?
This is the CRM Quick Link used to view status of correspondence submitted by providers.
What is Medical Provider Correspondence Disputes?
This is the MENTOR document utilized to give provider accurate address/fax information for Indiana Pathways Medical Records submissions.
What is Addresses and Payer IDs CCC Provider?
This MENTOR document allows me to search up to five codes and gives me probing questions.
What is the VOB Table of Contents CCC Provider?
CRI,Member ID,,First Name,Relationship
This is the example of a control line for the member screen that gives me this type of information.
What is COORDINATION OF BENEFITS?
This is the ONLY classification and intent used when logging an authorization.
What is
Class: Auth/Referral
Intent: Status
This is the system used to locate electronic claim images.
What is eHub?
A provider calls in needing information on how to add a provider to their roster. This is the document used to assist the provider.
What is Provider Issues CCC Provider?
This document gives additional details for handling claim status calls utilizing the claim explanation codes regarding code editing, bundling, billing error, corrected claim, correction, no payment, inaccurate payment, claim status, claim question, etc...
What is the EX Code Guide CCC Provider?
You are needing to see a referral from a member's PCP. This is the CAS screen you are searching.
What is the RSI screen?
True or False: There is no way to tell if a member has any other insurance in CRM.
What is FALSE
This is the system used to access status of check payments issued by Humana.
What is Check Status Inquiry Tool?
According to Transfer a Call CCC Provider, these are two instances that a call is ALWAYS consult transferred.
What are calls transferred to the ESCALATIONS UNIT or EXPEDITED APPEALS line?
REFERRAL AUTH LTNG is used for ________.
What is to determine if a procedure/cpt code needs prior authorization?
OH NO! DIG Toolbar is not working and a provider has called in asking for billing history for a specific durable medical equipment (DME) procedure code. This is an alternate search that can be conducted.
What is the DMI screen?
This is the location where we can see the member's benefit contract number.
What is:
Plan Member Page -> Details -> Eligibility ->Contract Information -> Contract ID
This toolbar is used to launch systems and automate processes.
What is DIG?
This MENTOR document has a listing of the documents that are most commonly accessed by Medical CCC Provider Advocates
What is Document Index CCC Provider?
The codes 066 and 088 indicate ______ in a claim.
What is the claim is a DUPLICATE?
You have to use CAS and cannot remember any of the control lines. This is the document you can use to assist.
What is CAS Screen List?
MRO, MER, MEP, MGP, MCD are all examples of _____ in CRM.
What is PRODUCT TYPE?