All About the Money
This department manages Medicaid funds and provider payments, ensures accuracy of claim reimbursements, and tracks and reports financial transactions among other responsibilities.
What is the Finance Department?
What are filters (instructor led, online course, course bundle, or curriculum)?
This tile in VUE360 allows you to search for and access claim data for medical and dental claims.
What is the Claims/Encounters tile?
This system is used to view notes from a provider call.
What is Gainwell Workspaces?
These help you mark emails that need follow-up, so you don't forget to respond or take action later.
What are flags?
In the case of a Medicaid beneficiary being involved in a car accident, this insurance coverage would typically pay first.
What is auto insurance with medical coverage?
This section of Gainwell University allows you to view courses assigned to you.
What is Assignments?
This is the process of evaluating a claim for payment of benefits and includes a review of beneficiary and provider eligibility, contract and contract terms, and benefits.
What is adjudication?
This tab is used in Gainwell Workspaces to view and add notes from provider calls.
What is CTMS?
Using neutral language and "I" statements can reduce this risk of this in a call.
What is the risk of further escalation?
This is the process of recouping/withholding money owed from future payments.
What is netting?
When you open an authorization in VUE360, you will get a notification in this situation.
What is if the authorization is linked to a claim?
This claim edit states that Benefit Requires Documentation to be Reviewed.
What is Edit 187?
Member lock in information can be viewed here.
What is under the Member tile in VUE360, under the Benefits, then Eligibility subtabs or in Gainwell Workspaces under Lock-In Details on the Beneficiary Info tab?
These are items on this list:
*No sensitive papers left on desk
*Computer locked or powered off
*Documents locked in drawers/cabinets
*Desk free of personal clutter
*Trash shredded if needed
*Surface wiped and sanitized
What is the Clean Desk Checklist?
These are used to generate edits when a certain condition monitored by the rule is met or not met.
What are Action Rules (IGNORE, WARN, PEND, DENY)?
These are standardized codes used to represent a patient's medical condition, illness, or reason for seeking healthcare services.
What are diagnosis codes?
The Provider Data Management System for DC is this.
What is Maximus?
You can run a Remittance Advice Report in VUE360 here.
Where is Supporting Systems-->SSRS Reporting?
This is the timely filing limit for a Medicaid claim that is a Medicare crossover claim.
What is 180 days from the Medicare paid date?
A claim in WAITDENY status is in this type of status.
What is Awaiting Finalization?
The Payment Reconciliation Report is run on this day of the week to identify payments that have not yet had checks issued.
What is Thursday?
Doing this to a claim prevents reversals and adjustments from being created.
What is locking the claim?
In The Well, you can use Contribution Types, Content, Contributors, and Groups to do this to your search results.
What is filter?
These are the claim formats used by hospitals, skilled nursing facilities, and home health agencies.
What are UB-04 and 837I?