WGS Screen Navigation 1
WGS Screen Navigation 2
Eligibility Edits 1
Eligibility Edits 2
WGS Navigation 3
100
Where should a claim be routed to in WGS if the claim indicates benefits should be applied manually?
Image processing queue
100
The DOB of the patient can be found on which screen?
Pac View 2
100
Which of the following users does the WGS Audit Trail screen keep track of?
Users who opened the claim live in order to process/modify it
100
On all Anthem Blue Crossplans, a newborn is covered within the first ____days of life
31 days
100
How many diagnosis codes can be on the PAC VIEW1 screen?
5
200
Which screen(s) can you access the WGS audit trail screen?
PAC VIEW1
PAC VIEW2
Image Processing Screen
200
you are navigating to get to the SUBS/DEPENDENT INQUIRY screen, You've already pressed shift + F2 what would you type next?
M2
200
How many ways are there to access the membership profile when verifying eligibility on a claim in WGS?
2
200
(you may only bet up to the amount your team currently has)
What requires some type of resolution before the claim can be finalized?
Hard Edits
200
A member has no claim but wants to see if he is active. What option do you press from the EXAMADJ Profile screen?
KK
300
You want access to the WGS Audit Trail Screen from the PAC VIEW 1 screen which combination would you press?
Shift F1
300
(you may only bet up to the amount your team currently has)
What screen is a claim processed in?
Detail
300
What six pieces of information will you need to gather to determine eligibility?
Member code
Member name
DOB
Group #
DOS
First 4 of contract code
300
True or False.
A 507 edit does not require the examiner to split specific line by line(s) based on when the member was eligible for benefits.
*note* answer if true or false and why?
FALSE.
300
True or False
You're on the WGS EOB screen and want to view the help screen for the payment system field. After clicking on the PMT SYS field you press the enter key.
False. F1
400
When trying to leave a screen that says "Corporate", what F key do you press?
F5
400
Which screen do we find if the provider is In Network or Out of Network?
Image screen or F11
400
What is the definition of an edit?
A warning that something on the claim needs your attention.
400
If the member is not effective on any contracts and there is no certificate number what is the next step?
Deny the claim R01030
400
What key is pressed to look up information on the red " pop ups"?
Enter Key
500
What screen(s) can the place of treatment (PT) Code be found on?
Pac View 2 and image screen
500
How is the Image 2 Screen accessed on a final claim?
MG pop up
500
Jake is a male subscriber. He recently got remarried following a divorce. He has two children. one boy and one girl. What member codes represent this story?
10
41
50
70
500
What information is used to verify if the newborn has been added to the policy?
*note: There are four components *
The name, date of birth, member code and gender.
500
Shannon is reviewing a member's claim history and notices the claim value type of "MEMBER" in the CLAIM TYP field.
What type of claim is shannon viewing on the Summary Claims screen?
Member submitted professional claim