HealthRules Manager Home Page
This will exit you out of HealthEdge completely if you click it.
What is the X (exit) button in the gray menu bar?
The claim's position after the auto-adjudication process. For example, Final, Denied, Needs Review, Needs Repair, or Rejected.
What is a Claim Status?
Where can you find message codes applied to a claim?
What is the lines tab? / What is the header tab?
The ability to locate a member by their name, ID, and/or birth date.
What is a member search?
The workbasket listing claims that did not successfully pass through the auto-adjudication process and need to be looked and/or fixed by a claims processor.
What is claim review and repair?
Located below the gray menu bar, this is the strip of other icons you can click on to search, edit, go to a workbasket, and more!
What is the blue ribbon/toolbar?
The location the claim came from prior to ending up in Payor.
What is the Claim Source?
Message codes applied to an explanation of benefits (EOB) or correspondence to inform the member/provider of something regarding the claim. (processing policies).
What is a User Message Domain (UMD)?
The number that differentiates one subscription from another subscription.
What is the subscription ID?
You can find what is causing the claim to route to the workbasket in this tab.
What is the exceptions tab?
A way to find a particular person's policy info and PHI who has Delta Dental of Colorado insurance using the icon that looks like a person.
What is a member search?
This is either listed as "Statement of Actual Services" or "Pre-Determination."
What is the Transaction Type?
User created message code that can be referenced in configuration to route a claim to the review workbasket (error code reasons). Applied during the adjudication process.
What is a CRUM code?
The date the member's policy became active.
What is an effective date?
A way for you to select additional columns to add to your workbasket or to a member's claims tab.
What is the column chooser?
A card on your home page that displays how many claims are in your workbasket.
What is the My Work card?
You can find the date of service, procedure code(s), payment information, benefit tier, fees, and tooth, surface and oral cavity here.
What is the lines tab?
A message code that is used to inform a member and provider of why the claim or procedure code was processed in the way that it was - this code does not request information.
What is an informational code (I-code)?
The location of the member's previous visits to the dentist, showing the provider they visited, services codes, and the date the service was completed.
What is the claims tab? (Bonus: Show Lines)
This feature allows you to expand your view of a claim and minimize your workbasket.
What is the blue bar?
A customizable card in which you can add all of your most used options in the home page.
What is the favorites card?
What is the view input?
A message code that can be applied to a claim during the adjudication process that is usually placed on a member, practitioner, supplier, or account record.
What is a CRR code?
This tab displays if the member on your subscription has any other subscriptions with Delta Dental of Colorado.
What is the linked members tab?
A place where you can find comments from people who might have worked on a claim / Where your comments go when you complete a claim.
What is the audit log?