Claim Edits
A surgery claim submission would be submitted using this transaction type.
What is an 837?
These are a grouping of data elements that start with an ID or code.
What are Transaction File Segments?
This is the goal of CSR agents when handling provider inquiries.
What is resolve all cases on the first call?
From the list below, this is not one of the four main types of FQHCs:
-Community Health Centers
-Migrant Health Centers
-Rural Emergency Clinics
-Public Housing Primary Care
What are Rural Emergency Clinics?
From the list below, this is a recommended technique for effective telephone communication with providers:
-Use technical jargon to sound knowledgeable
-Avoid summarizing to save time
-Use empathetic phrases and confirm understanding
-Speak quickly to reduce call duration
What is use empathetic phrases and confirm understanding?
This intermediary routes EDI data between providers and Medicaid and submits the Trading Partner Agreement.
What is a clearinghouse?
This transaction rejection report summarizes the EDI rejections.
What is the BRR report?
Agents should use this feature instead of the Hold button during a call.
What is Mute?
Long Term Care is daily support for an extended period of time, including help with eating, dressing, and bathing, that is provided here.
What is in a nursing home?
This toolbar in the DC Provider Web Portal helps providers access help, language settings, and their user profile.
What is the Global toolbar?
This claim edit is triggered when a benefit requires supporting documentation before processing.
What is Edit 187?
A TA1 report is accepted if you see this letter, followed by 000.
What is A?
This is the type of listening that you should use on provider calls.
What is active listening?
Managing multiple insurance coverages for a member is this.
What is Coordination of Benefits (COB)?
Claims are adjudicated in real-time with reduced error rates in this type of claim submission.
What is Electronic Data Interchange (EDI)?
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Answer
This symbol is used to indicate the end of a segment in an EDI transaction file.
What is a tilde (~)?
This is the Golden Rule of HIPAA.
What is the Minimum Necessary Rule?
Kick payments are triggered by these.
What are delivery and newborn claims?
This is the number of successful test files per transaction type that is needed to gain production authorization for X12 file exchange.
What is 3?
This is what you should advice a provider if a claim has Edit 302.
What is "This claim has been pended because it’s for an inpatient service and is missing the attending physician information, which is required for processing. Since this is a paper claim, it’s currently under review by our claims team. If the attending physician details were omitted, please resubmit the claim with that information included to help move it forward"?
This transaction file confirms the claim transaction is properly formatted and compliant.
What is the 999 transaction file?
Recoupments should be researched here.
What is the Finance tile in VUE360?
To find the Medicaid level for a beneficiary, you will go here in VUE360.
What is to the Member tile, and then to Benefits and Eligibility?
Collecting data from caregivers is done through this technology.
What is Electronic Visit Verification (EVV)?