Claim Tab
This subtab provides the claim general information and all the details surrounding a specific claim.
What is the Claim Header Subtab?
The Pay tab defaults to this subtab, which provides line level payment information.
What is the Claim Pricing Details subtab?
The top of which section within the Edits subtab provides a running total of how many adjudication attempts have occurred?
What is the Edit Details section?
This subtab displays the details of the primary carrier’s dispensation of the claim, including allowed, payment, and member cost share amounts.
What is the COB Claim Details subtab?
This subtab displays the original claim high-level information and all adjustments or reversals performed on this particular claim over its history.
What is the Adjustment History subtab?
This subtab displays information found in the service lines on the claim.
What is the Service Line Subtab?
This subtab provides a medium to store memos pertinent to the processing of claims.
What is the Memos subtab?
This subtab provides the adjudication hierarchy and is an extremely useful tool to understand, research, and audit claims adjudication.
What is the Step Edit subtab?
This subtab contains coordination of benefits enrollment information.
What is the Claim COB Enrollment?
When a claim enters the system via the EDI method, the _________ subtab provides process log information for claim investigation.
What is the Processing Details subtab?
This subtab displays information billed on 1500 and UB04 claims regarding the attending, operating, referring, or other providers.
What is the Providers Subtab?
This is the subtab where you would find information such as trading partner ID and claim type.
What is the Claim Attribute subtab?
This subtab displays the rate code and coverage code from the member’s eligibility.
What is the Enroll Coverage Audit subtab?
This table includes the consolidated payment and information regarding the COB.
What is the COB Totals table?
The GPCS subtab defaults to a GPCS Details window, which displays an input and output ____ tab.
What is JSON?
The Check In Date and Time for a home visit is displayed in the _______ subtab.
What is the EVV subtab?
This subtab displays limits and maximums reached that have been applied on the current claim.
What is the Limits subtab?
This subtab contains adjudication history data.
What is the Edit History subtab?
This section contains other carrier information the member might be enrolled in.
What is the Claim Other COB Enrollment section?
This is a software component that is integrated with Administrator to ensure that code and claim editing rules are accurate and consistent with standard business practices.
What is ClaimsXten?
You would use the ________ functionality to stop a claim from going through adjudication.
What is the HOLD/RELEASE button?
This is the subtab where a claim analyst would look after doing research on a claim to add or remove pricing manually.
What is the Claim Pricing Detail subtab?
Step edits show the _____ applied to the claim through custom business rules after the baseline business rules.
What are Claim Extensions/Stored Procedures?
In this subtab, you can find the COB method applied to the claim.
What is the COB Claims Details subtab?
Under the ClaimsXten subtab, there are four additional subtabs. Name them.
What are details, claim history, input XML, and output XML?