HCSC TERMS

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