HCSC TERMS

1. -Explanation of Benefits
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.
9. System used specifically to check for EOB’s for ITS claims
11. Employment Verification Process used to verify status of an employee (ex: COBRA, retired active)
12. System located in HCSC systems that house Commercial COB information
14. Real Time Benefits
15. Used to look up and review Medicare records instead of calling Medicare
16. Refund Credit
17. Work in Progress
19. Eligibility system for individual plans
20. part of member verification used to update COB solutions & Bluestar
21. To send a claim over for approval and receive credit for overpayment
23. Placing a match on hold for later review
27. another way to view info about the subscriber/patient. Customer service platform where notes from incoming calls are kept
29. Part C Medicare Advantage- type of health insurance the provides coverage within Part C of Medicare
32. Contract provision in a health care plan that is applied when a patient is covered by 2 or more group health insurance plans
33. System used for EOB’s for all claim types

2. Source Location of standard operating procedures, can be located through FYI Blue or Related links in GUI
3. Folder Note- special processing instructions – found in ECM
4. eligibility System for Group Plans
5. Health Care Service Corporation, consists of five states IL, MT, NM, TX, OK
6. Graphical User Interface- uses windows icons and menus and can be manipulated by a mouse
7. – system used to look for EOB’s on ITS claims (claims ending in H) also known as B2
10. Consolidated Omnibus Budget Reconciliation Act
12. Consumer Driven Health Plan, amount paid by a member’s FSA/HSA/HRA
13. When a patient is covered by two BCBS policies within our 5 states
14. To remove a match from WIP
15. Retail Retro- Used to check Eligibility in Retail (Non Group) accounts
18. Centers for Medicare and Medicaid Services
22. term for claims that are performed in a different state than the policy is from
24. Date of Service- the date a service was performed
25. Financial Suspense System
26. Notating an account that you are in the process of listing matches/family file
28. service request- found in dashboard
30. Lock stored within claim lock application database-located in related links in GUI or through FYI blue
31. System where EOB’s, Evidence of OI, FNOT’s and Correspondence can be found