Benefits
Product Terminology
Edits and Pop-ups
WGS
Mixed Bag
100
Press these keys to view Benefits while in Inquiry mode
What is SHIFT and F7
100
HMO
What is Health Maintainence Organization.
100
To view an Edit in WGS, do this
What is place your cursor on the Edit and press F1.
100
WellPoint Content Framework allows you to
What is view an image of a claim.
100
Web application used to price medical services
What is NetworX Pricer.
200
Benefit screen that has contract administration information
What is the Benefit Administration screen
200
PPO
What is Preferred Provider Organization.
200
When this occurs a DP pop-up will fire
What is possible duplicate claim(s).
200
Claims can be finalized on these two screens
What is the Image screen and PAC View 2.
200
to price a claim in NetworX Pricer type the DCN into this field while in this inquiry
What is the Claim Number field while in Claim Inquiry.
300
Benefit screen that houses a summary of the members contract
What is the Benefit Summary screen
300
Health providers that have signed contracts with an insurer to provide services for its members are considered to be
What is Participating (PAR) or In-Network
300
To view a Pop-up, you must
place your cursor on the Pop-up and press ENTER
300
View member's eligibility with these steps
What is press SHIFT F2, M2, and IN from PAC View 1 or PAC View 2
300
HIA, HIA+, HSA, HRA are examples of
What is consumer driven health plans (CDHPs)
400
To view a procedure's service category, navigate to one of these screens
What is PAC View 2 or Image Screen.
400
The benefit portion amount that the member pays once the deductible is satisfied
What is the co-insurance
400
This is the 1st step in resolving an pre-authorization edit
What is viewing the UM Respository to search for an authorization.
400
Press this button to view Benefits in a live claim
What is F10
400
In WGS DX1-5 are viewed on these screens
What is PAC View 1 and PAC View 2.
500
To view a physician's speciality, do this
What is press F1 while the cursor is on the provider's tax ID on PAC View 1
500
The amount that a member must pay before the insurer begins paying 100% of covered medical costs.
What is the out-of pocket (OOP) or Stoploss (S/L)
500
The NX pop-up contains
What is rate sheet or pricing rate information
500
Use this tool to discover how much a member has paid out during the benefit year
What is the Accumulator.
500
In WGS an additional modifier can be viewed where
What is the second screen of the DS pop-up
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