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This department manages Medicaid funds and provider payments, ensures accuracy of claim reimbursements, and tracks and reports financial transactions among other responsibilities.
What is the Finance Department?
What are filters (instructor led, online course, course bundle, or curriculum)?
Claims in this status have failed business rules and have gone through the payment process.
What is DENIED?
This system is used to view notes from a provider call.
What is Gainwell Workspaces?
This is a unique 10-digit number assigned to healthcare providers.
What is a National Provider Identification (NPI) number?
In the case of a Medicaid beneficiary being involved in a car accident, this insurance coverage would typically pay first.
What is auto insurance with medical coverage?
This section of Gainwell University allows you to view courses assigned to you.
What is Assignments?
This is the process of evaluating a claim for payment of benefits and includes a review of beneficiary and provider eligibility, contract and contract terms, and benefits.
What is adjudication?
This tab is used in Gainwell Workspaces to view and add notes from provider calls.
What is CTMS?
These are the EDI transactions for healthcare claim payments and adjustments and remittance advices from Medicaid to providers.
What are 835s?
This is the process of recouping/withholding money owed from future payments.
What is netting?
This can also be PHI if it is connected with information about someone's healthcare.
What is PII?
A claim status of WAITPAY or WAITDENY means that a claim is waiting for this.
What is for the financial cycle to process?
Member lock in information can be viewed here.
What is under the Member tile in VUE360, under the Benefits, then Eligibility subtabs or in Gainwell Workspaces under Lock-In Details on the Beneficiary Info tab?
This is the timely filing limit for a Medicaid claim that is a Medicare crossover claim.
What is 180 days from the Medicare paid date?
These are used to generate edits when a certain condition monitored by the rule is met or not met.
What are Action Rules (IGNORE, WARN, PEND, DENY)?
These are standardized codes used to represent a patient's medical condition, illness, or reason for seeking healthcare services.
What are diagnosis codes?
These are five valid claim statuses that you can select when searching for a claim under the Provider Tile in VUE360.
What are any of the following: ALL, OPEN, DENY, PAY, PEND, ADJUDICATED, DENIED, PAID, REV, REVSYNCH, VOID, REVERSED, WAITDENY, WAITPAY, WAITREV?
This tab within the Operations tile allows authorized users to filter edit results.
What is Claims Resolution?
A CSR selects this in Gainwell Workspaces to begin escalating an issue.
What is Transfer under Status in CTMS?
If a claim is pending for Invalid Medicare Action Code, but Medicare has not made a payment and the diagosis is covered by Medicaid, you would perform this action.
What is override the PEND edit to Okay status?
The Payment Reconciliation Report is run on this day of the week to identify payments that have not yet had checks issued.
What is Thursday?
Doing this to a claim prevents reversals and adjustments from being created.
What is locking the claim?
This subtab under the Operations tile in VUE360 allows supervisors to see or reassign one or more claims to authorized users.
What is the Claims Resolution Supervisor subtab?
The Claims and Finance Teams will receive escalations via a notification in this system.
What is Verint?