Systems
HRP Features
HRP Claims
Disney Quotes
Processing Instructions
100
This is the system used in CB to process claims.
What is HRP?
100
This is where we go in HRP to look for a claim to process.
What is the workbasket?
100
This is what to press when you want to see how the changes you've made will affect a claim.
What is "Preview Result"?
100
"Let it go."
Who is Elsa?
100
These must always match when finding a supplier location.
What are the service address and NPI?
200
This is the system used to check for authorizations.
What is Active Advice / Active Health Management?
200
This is the button we have to click to actually begin processing a claim.
What is "Open For Edit"?
200
If we want the changes we've made on a claim to take affect, this is the button we should click on the "Edit Claim" screen.
What is "Approve"/"Submit"?
200
"Reach for the sky!"
Who is Woody?
200
This is where COB information is housed if submitted on a claim.
What are the CSV file and/or Other Insurance Payments and/or View Input?
300
This is the system used to check whether a provider is in network.
What is Smart Front End?
300
These are the steps to take to be able to see all a member's claims.
What are, search for the member and go to the "Claims" tab?
300
If a claim line is denying, but we want it to pay and finalize, this is the step we should take.
What is "Override denial"?
300
"That hairball is my son. And *your* future king."
Who is Mufasa?
300
This must always match on the supplier location for institutional claims.
What is taxonomy/classification?
400
This is the system used to check specifics on coverage, processing instructions, and procedures.
What is e.Policies?
400
This is the button you can click in order to add notes to the audit log without opening a claim for edit.
What is "Add a Comment"?
400
These are the steps to pend a claim.
What are, go to the header, select "UserMessages," click "Add," and add the correct pend code?
400
"Life is a journey to be experienced, not a problem to be solved."
Who is Pooh?
400
These are the three most common groups for which an issue will need to be created.
What are SIU, CCR, and CM?
500
This is the system used to check a member's payment / grace period status.
What is ServiceLink Portal?
500
This is where you can go to modify the pricing section if the deductible needs to be waived.
What is "Adjust Financials"?
500
This is what tells us why a claim is denying.
What is a message code?
500
"Conscience be your guide."
Who is Jiminy Cricket?
500
When matching an auth in Active Advice, these must match the claim.
What are DOS, provider name, and diagnosis?
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