Claims

1. is a statement that explains what services have paid and what is owed. Voucher is used interchangeably with explanation of payment(EOP).
5. Place of Service
7. Home Health Insurance Prospective Payment System
11. Participating providers accept the payment amount that the plan approves using Medicare guidelines, and the member will be responsible for any corresponding deductible, copay or coinsurance.
13. When customers use medical coverage, we send a detailed report. This is a monthly report that lists the services received, what the provider billed, what the plan paid, how much the customer may owe, and an explanation of denial, if applicable. The customer receives the____
14. is an indication that the claim is incomplete or missing data and will not be processed
15. is when the plan takes back money from (underpays) a provider who we may have overpaid on a MA account that is not the original
17. A professional or ancillary provider, like a cardiologist or a radiologist, are providers who will bill the plan on a___
18. is a claim in which the plan has paid the member, the plan has paid the provider, or the member has paid the provider.
19. is a claim that has been paid or denied and then the claim is reversed.
20. is when the plan overpays a provider for a MA account that is not the original MA account

2. uniquely identifies the claim in ikaSystems.
3. a document that describes member benefits to providers. This document helps providers understand how they should be paid.
4. Health Care Common Procedural Coding System
6. is the deadline of when a claim can be submitted for
8. is when the plan decides to take money back from a provider for a paid claim.
9. is when a provider sends money back to the plan because the provider was overpaid by us
10. A facility provider or hospital providers will bill the plan on a____
12. Current Procedural Terminology
16. is a request for payment by a member or by a health care provider for services performed