Tabs
The default tab within Claims Inquiry that allows you to view services rendered, line charges/paid amounts, linked auth/referral information, provider par status, and disallow explanation codes
What is Line Item Details?
Allows you to view the hard copy/OCR image of the claim, as it was submitted by the provider. Also lets you see any attachments they included in the claim submission (i.e. MEOB, Invoice)
What is DMS?
The code used to indicate that services are being rendered in the office setting
What is 11?
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Claim adjustment/review, Provider file updates, Late contract loads/pricing issues, and Configuration issues
What are the common types of claim inquiry?
"The last known survivor stalks his prey in the night, and he's watching us all with the _______."
What is The Eye of the Tiger?
This tab allows you to view member details, servicing provider details, and PCP information
What is the Member/Provider tab?
Aids in locating the correct referral or authorization for claims
What is Prospective UM?
e, f, g, h, i, j, l
What are ClaimsXten denial codes?
Claims with invalid or missing data elements, such as the tax ID number, that are returned to the submitter or EDI source without registration in the claim processing system (Facets)
What is a rejected claim?
This Vegas casino is one of the tallest pyramids in the United States
What is the Luxor Hotel and Casino?
This tab allows you to view the check #, EFT #, payment date, and check amount
What is the Remittance Tab?
Allows you to check the pricing information on a claim
What is the Medical Agreement Configurator?
Identifies the diagnosis or condition of a patient on claims with dates of service on or after 10/1/15
What are ICD-10 codes?
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Total Charge- $1,550.00
Medicare l Medicaid
Allowed- $1,175.00 $990.00
Ded- $183.00 N/A
Coin- $198.40 N/A
Copay- $0.00 N/A
Paid- $793.60 ?????
What is $196.40?
This character has been notable for her volatile diva personality, tendency to use French phrases in her speech, and practice of karate. She was also known for her on-again/off-again relationship with a co-star, which began in 1978 and has been on a hiatus since 2015.
Who is Miss Piggy?
In this tab, you are able to view the received date of the claim, as well as the input method, network status, claim explanation, and all diagnosis codes billed
What is the Claim Information tab?
The system that allows to to verify the member's medicaid eligibility status and MCO history
What is EMEVs?
Identifies supplies, drugs, and durable medical equipment (DME) provided by a doctor or hospital to a patient
What are HCPCS?
You must verify that these three things match when determining if the rending provider and PCP are in the same group
What is the group ID, group name, and tax ID number?
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A classic game show -- with a twist. The answers are given first, and the contestants supply the questions.
What is Jeopardy?
*DOUBLE JEOPARDY*
This tab allows you to view the facility name, type of bill, medical record number, admit/discharge dates, and the patient status code
What is the Hospital Information tab?
The core system used by Horizon NJ Health to view and process claims, view provider/subscriber/COB files, Core and NetworX pricing, referrals and authorizations, and to document and route inquiries
What is Facets?
This code indicates that a claim has been adjusted
What is status code 91?
If the event that the provider is unable to provide you with the claim ID number, you can use this search criteria to locate the claim in question
What is the Member ID # and DOS?
Wallace Shawn uses this word several times in "The Princess Bride"; Mandy Patinkin questions its usage
What is inconceivable?