CLAIMS
This is used to determine what is being billed by procedure.
I can use this tab to look at individually billed CPT codes.
what are the lines tab
This is where we find the link for SFE
What is wiki
This is where we can see the monthly claims breakdown
This is the name of the claim option in the application
Manual claim form number for hospitals
When I have to send a claim back for rework, I use this button
what is the new issue button
What are common roles we will see.
PCP, SPEC, NONE, Both
We can send the members EOB to the provider, True or False
False, not without the members permission
this system houses rates
What is Rate Inquiry
This is a characteristic of a manual paper claim form.
What is a claim that starts with a M
This is where you find provider participation
what is header, additional information
12319999 means this contract expires when
Never
To see if a deductible applied to a claim, we search here.
what is accumulators, associated transactions
In CXT, you can search frequency, true or false
True
What is sequestration
This is where the benefit level is housed
Under lines, benefit adjudication
Network tab shows what providers are in network. True or False
False, network tab shows what networks the provider accepts
This we can expand and see more detailed information on the claim
what is claim lines
We use these two rates to find the allowable or reasonable rate
What is REF and MCARE
This handles workers comp claims.
what is subrogation
What are the 5 claim status that we will see
Final, void, denied, needs repair, needs work
I find the POIN here
What is IPA tab
This SR reworks a claim that is incorrect
What is claim rework SR
M24.48 is this type of code
what is a DX code.