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  1. 3. (EMSG0067) THIS LINE SPANS TERMINATION OF ________ DATE PLEASE SPLIT LINE AT MM DD CCYY
  2. 5. (HMO Illinois Ambulance Claims) Dollar Limit Changes (for Cross Claims) - The $1000.00 dollar limit to pay ________ claims as GA
  3. 6. (HMO Illinois Home Health Service Claim Processing Guidelines) Home Health Care services fall into 4 categories; infusion drugs and ________, blood derivative services, home health visits, and hospice visits
  4. 7. (HMO Illinois Processing GAP Claims) A GAP approval is a pre-approval __________ between a provider and the medical group.
  5. 8. (HMO Illinois Processing GAP Claims) If a claim is received with an NGA stamp from the medical group and meets GAP criteria, this is a ___________.
  6. 10. (HMO Illinois Guest Member Questions) If the member indicates they have already contacted the Host plan, contact a ___ for further direction.
  7. 13. (HMO Illinois Processing Claims Stamped Not Group Approved by the Medical Group) Medical Group Submitted Claims - At times, HMO receives claims submitted by the Medical Group. The Medical Group may receive a claim ______________ from the provider and re-create the claim in their system to submit to HMO.
  8. 14. (HMO Illinois Risk versus Clinic Risk) HMO claims are divided into two types of financial responsibility. This is known as "____ for payment".
  9. 15. (HMO Illinois Processing Unstamped Claims)___ claims are not considered unstamped.
  10. 16. (HMO Illinois Processing Unstamped Claims) Some claims are received without a _____ from the Medical Group
Down
  1. 1. (HMO Illinois Home Health Service Claim Processing Guidelines) Must be provided by an HMO ___________ provider in order for the services to be HMO Illinois risk to pay
  2. 2. (HMO Illinois Redirect Process) This will allow claims that are medical group risk to automatically be routed to the patient’s medical group through ___ without operator intervention.
  3. 4. (HMO Illinois Guest Member Questions) A Guest Member remains a member of the Home HMO, and the __________'s premium continues to be paid to the Home HMO.
  4. 9. (HMO Illinois Processing Claims Stamped Group Approved by the Medical Group) Most HMO claims require Medical Group ________ in order for a payment to be made
  5. 11. (Provider Number Research (PNR) Tool) The operator is responsible for reviewing the provider returns and to choose the appropriate provider number based on the ________ being billed, the provider type and specialty codes.
  6. 12. (HMO Illinois Institutional Risk Table)Outpatient surgery hospital claims billed with a date span should be paid under one ___