Claiming Knowledge
A claim in this claim status has failed business rules and has gone through the payment process.
What is DENIED?
At the end of your scheduled workday, you should do this in CXOne to remove yourself from the queue.
What is click Log Out in the status menu?
This type of billing using clock-in and clock-out times, GPS or caller ID, and data transmission to compare claim data via MMIS systems.
What is EVV billing?
Payment for DRG is made in this way.
What is in a single lump payment for the entire stay?
You must be in this state in CXOne to receive or send emails.
What is Available?
A claim in this status is approved and in the payment process, but it's not yet complete.
What is WAITPAY?
You need to provide this information if you call the backup service line for the Language Line.
What is our Client ID and your first and last name?
Providers can retrieve their remittance advice under this menu on the Provider Portal.
What is the Reports menu?
To search for a payment in the Financial/AR tab in Gainwell Workspaces, you need at least these pieces of information.
What are the Provider NPI/API and a From and To Date of the payment?
A deaf or Hard of Hearing (HOH) person can dial this number from their TTY device to be routed to a Telecommunications Relay Service (TRS).
What is 711?
Kick payments are sent to MCOs after qualifying claims are matched to these.
What are encounters?
You should speak to a caller in this way when speaking to them through an interpreter.
What is you should speak to them in first person?
If a provider calls about error code 101 on a claim, you will advise this.
What is there's no active contract on file for the provider?
A Health Care Claim Institutional electronic file is better known by this short name.
What is 837I?
The default status for chats in CXOne is this.
What is Open?
As of 3/2/2026, paper claims will need to be sent to this PO Box for DC Medicaid.
What is 33428?
This is how long you should keep a caller on hold and how often you should check back in with them.
What is no longer than two minutes and provide a check-in within 60 seconds?
A provider can check for beneficiary lock-ins here on the portal.
What is under Verify Member Eligibility?
Recoupment information can be researched here.
What is in the Finance Tile in VUE360?
This is how often prior authorization data is exported to Sandata for EVV.
What is weekly?
Lock-Ins are typically tied to these types of care for DC Medicaid.
What is hospice and nursing home care?
You would research error code 1124 in this Gainwell Workspaces tab.
What is Claims?
Providers can update their EFT information in this way.
What is by contacting Maximus?
These criteria impact DRG pricing.
What are patient primary diagnosis, length of hospital stay, and weight assigned to the provider by Medicaid?
Trading partners that want to be certified to submit X12 EDI Transactions must submit this number of test files with a minimum number of this number of transactions in each file.
What is 3 test files with a minimum of 15 transactions in each file?