PDM
These are professionals that deliver services, perform procedures, or dispense products
What are Providers?
Which Menu Function is used most often to view Claim Profiles?
What is the Processing Menu?
Or
What is Processing?
On a Claim Profile, R, P, and Z are these types of codes.
What is a (Claim) Status Code?
What does CQE stand for?
What is Claims Queue Extract?
What types of partners does PDM work with?
Hint: There are two answers
What are Fully Administered and Partially Administered (Partners/Clients)?
This PDM team is responsible for ensuring that the provider data stored in Aldera is correct.
What is the Operations Team?
The best search type to complete to pull up provider records is . . .
What is a Service Location Search?
The person or company (lab or other facility) that rendered (provided) services/care to a patient.
Who is the Rendering Provider?
What Claim review Types are selected for Load Files? Hint: There are two.
What are Load File Needed and Out-Of-Network (OON) Load File Needed?
What are the three layers/branches of provider data on an Aldera record?
Hint: There are three answers
What are Provider, Business Unit, and Service Location?
The Credentialing team does what?
Organizes, researches, and verifies provider records and credentials (e.g., education, degrees, identity, licenses, work experience, sanctions, etc.) through primary source verifications or manual confirmations of the information provided.
This record type includes things like tax information, payment information, and address.
What is a Business Unit?
The RF-Billing line on a claim is . . .
The entity or individual submitted on a claim form that the payer issues payments to.
Affiliation information that is verified in a Load file are Effective & Term Dates, and . . .
What is Affiliation Name?
These are the teams within the PDM department?
Hint: There are three answers
What are the Implementations, Credentialing, and Operations teams?
Claims, Config, and Enrollment & Eligibility (E&E) are . . .
What are (some of) the departments that PDM interacts with?
This icon allows you to open an additional Aldera screen.
What is the Open a New record icon?
What link should you click to display paper images of claims?
What is the View Image (link)?
Provider data that did not load into Aldera is found in which tab of a Results file?
What is the Rejects tab?
What are the three types of claim forms processed in Aldera?
Hint: There are three answers
What are the ADA, CMS-1500 (HICFA), and UB (Claim forms)?
This PDM team works with EHS’s new partners and the Project Management Organization (PMO) to gather requirements to develop and configure our Provider Pipeline.
What is the Implementations team?
When Yes is selected in this field, active and inactive records display in search results.
What is the Display InActive (search) field?
What can you click from a claim to navigate to a provider record displaying all three branches?
What is a provider’s license number or N/A (link)?
Manual Selects are found in which tab of a Results file?
What is the Success Tab of the previous day's Results file?
What are the first pieces of provider data that Provider Matching Logic tries to match to a claim during auto-adjudication?
Hint: There are four answers
What are NPI1 | TIN/NPI2 | SL first 5 Chara | SL Effective & Term Dates?