HCSC TERMS

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Across
  1. 1. -Explanation of Benefits
  2. 8. Number A 4 digit number used in trilogy to identify what state a claim is processed in and if Non –ITS, ITS, Individual or Medicaid.
  3. 9. System used specifically to check for EOB’s for ITS claims
  4. 11. Employment Verification Process used to verify status of an employee (ex: COBRA, retired active)
  5. 12. System located in HCSC systems that house Commercial COB information
  6. 14. Real Time Benefits
  7. 15. Used to look up and review Medicare records instead of calling Medicare
  8. 16. Refund Credit
  9. 17. Work in Progress
  10. 19. Eligibility system for individual plans
  11. 20. part of member verification used to update COB solutions & Bluestar
  12. 21. To send a claim over for approval and receive credit for overpayment
  13. 23. Placing a match on hold for later review
  14. 27. another way to view info about the subscriber/patient. Customer service platform where notes from incoming calls are kept
  15. 29. Part C Medicare Advantage- type of health insurance the provides coverage within Part C of Medicare
  16. 32. Contract provision in a health care plan that is applied when a patient is covered by 2 or more group health insurance plans
  17. 33. System used for EOB’s for all claim types
Down
  1. 2. Source Location of standard operating procedures, can be located through FYI Blue or Related links in GUI
  2. 3. Folder Note- special processing instructions – found in ECM
  3. 4. eligibility System for Group Plans
  4. 5. Health Care Service Corporation, consists of five states IL, MT, NM, TX, OK
  5. 6. Graphical User Interface- uses windows icons and menus and can be manipulated by a mouse
  6. 7. – system used to look for EOB’s on ITS claims (claims ending in H) also known as B2
  7. 10. Consolidated Omnibus Budget Reconciliation Act
  8. 12. Consumer Driven Health Plan, amount paid by a member’s FSA/HSA/HRA
  9. 13. When a patient is covered by two BCBS policies within our 5 states
  10. 14. To remove a match from WIP
  11. 15. Retail Retro- Used to check Eligibility in Retail (Non Group) accounts
  12. 18. Centers for Medicare and Medicaid Services
  13. 22. term for claims that are performed in a different state than the policy is from
  14. 24. Date of Service- the date a service was performed
  15. 25. Financial Suspense System
  16. 26. Notating an account that you are in the process of listing matches/family file
  17. 28. service request- found in dashboard
  18. 30. Lock stored within claim lock application database-located in related links in GUI or through FYI blue
  19. 31. System where EOB’s, Evidence of OI, FNOT’s and Correspondence can be found