Code Read
This type of claim may have codes that do not match or are invalid and may have missing information, such as patient date of birth or beneficiary ID.
What is an unclean claim?
This determines if you will clear Edit 913 from claim.
What are operational requirements?
If there are thousands of claims with enrollment status changes, this process should be run.
What is Auto Adjustment?
These are some of the benefits of DPA.
What are?:
Increases operational efficiency
Enhances quality and compliance
Supports cost reduction and process improvement
Improves process performance
Meets service goals
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What is Saturn?
These codes tell Medicaid how Medicare handled a claim (paid, adjusted, denied).
What are Medicare Action Codes (MACS)?
For Edit 302, you will do this if you add an attending provider to the CEF claim and receive an error that the provider is not found.
What is add a memo to the claim and deny the claim?
A claim status of WAITPAY or WAITDENY means this.
What is that the claim has to wait for the financial cycle to process?
The Mass Adjudication Module is accessed in this system.
What is Administrator?
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What is blue?
Claims that require manual pricing will enter this phase.
What is suspended claim phase?
For Edit 301, you will do this if the date of admission on the CEF claim is blank.
What is edit the claim in CEF?
This is your next step with Edit 187 if the Service Code is 58951 and a blank Consent for Sterilization Form is attached to the claim.
What is add a memo and deny the claim?
Auto Adjustments are run here.
What is in the Utilities section of Administrator?
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What is The Big Bang Theory?
Doing this to a finalized claim prevents reversals and adjustments from being created.
What is locking the claim?
For Edit 203, if the procedure code/CPT code and revenue codes listed on the paper claim match the claim in CEF, you will do this.
What is deny the claim?
If you review a claim with Edit 217, and the paper claim shows a DOS of 2/5-2/15/25, but the CEF claim shows a date of service of 2/6-2/16/25, this is your next step.
What is data correct the information in CEF to match the paper claim and then adjudicate the claim?
The Mass Adjudication process flow has these 6 steps.
What are?:
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What is Voyager 1?
If a claim is pending for an Invalid Medicare Action Code and Medicare has not made a payment and the diagnosis is covered by Medicaid, you will do this.
What is override the PEND edit to Okay status?
You will begin researching Edit 168 with these steps.
What is by checking the Date of Service (DOS) of the paper claim against the DOS of the CEF claim?
When reviewing Edit 204, you should do this if the Value Code shown on the CEF claim shows 81 with covered days of 6, but the paper claim image shows 80 with a covered days of 7.
What is update the Value Code and covered days and revalidate the claim?
For Edit 224, if the claim is dated 8/7/25 and has procedure code D0150, and you see that this procedure code was previously billed for the beneficiary on 7/1/25 and paid on 9/5/25, you would do this.
What is deny the claim?
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What are elliptical galaxies?