Inquiry Tracking
What to Do
Processing Adjustments
WGS
Adjustments
100
This screen lists the reason for the adjustment request and the DCN that needs to be adjusted.
What is the Text Inquiry screen
100
To enter a new text note, you must
What is type Y in the in the TEXT field from PAC View 1. Complete your notes. Type L in the Log field and press Enter. New TX pop-up should display.
100
DCN, Unit, Adjustment Reason Code, and the MLH, IINQ number
What are the four pieces of information needed to start a claim adjustment
100
To access the Claim Adjustment Request screen, what must be typed into the EXAMADJ Profile screen
What is AA
100
Supplemental, Statistical, Automated
What are the 3 types of adjustments that Claims Adjusters can process
200
When pressed from the Text Inquiry screen, the function of the F4 key is _________
What is view the claims history of tagged DCNs
200
Overpayments greater than this should be routed to CCOA for collection
What is $50.00
200
The date in the MLH/ IINQ field is used to...
What is calculate interest payments for re-receipt and prompt payments penalties.
200
Two places in WGS usedn to access the adjustment mode
What are Inquiry Tracking and Claims
200
CCOA
What is Cost Containment Overpayment Avoidance
300
The key pressed to begin an adjustment from Inquiry Tracking
What is F5
300
When viewing an adjusted claim, this displays in the Claim Type field
What is ADJ
300
When adjusting a claim, information must be removed from this location first
What is the ACT field
300
Do this to access pended adjustments in WGS
What is type a Y in the Adjust field on the PAC/ Initalization screen
300
Full credit, partial credit, and overpayment reversal adjustments must be sent here
What is to CCOA
400
The menu option used to access adjustment requests
What is the CC routing queue
400
To adjudicate an adjustment, this should be done
What is change necessary data on the PAC screens, and type A in the LOG field of PAC View 1 or 2.
400
Do this to refresh a claim adjustments in PAC View 1
What is type CLEAR into the PEND field
400
To access a pended adjustment, these four fields must be completed on the PAC/ IMAGE Initalization screen
What is Select By Specified Queue, Unit, Adjust, DCN1
400
Type of adjustment that increases the original payment and issues additional benefit
What is Supplemental
500
Upon completing an adjustment, you may need to do this to go back into Inquiry Tracking,
What is press the F3 button
500
Once all corrections have been made to an adjustment in the PAC View screens, this should be done to finalize
What is F6 to the IMAGE screen, finalize all edits, and DEPRESS ENTER TO LOG TO BATCH
500
To cancel an adjustment, this must be done
What is type ACLOSE in the ACT field while in the adjustment
500
On the Claims menu screen, this option should be selected to access a pended claim and this option should be selected to initialize a claim adjustment
What is BB to access a pended claim and DD to initialize a claim adjustment
500
Type of adjustments for the following reason codes: P01, X17, S53, A12, F31
What is Partial Credit, Supplemental, Statistical, Automated, and Full Credit
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