Resources and Tools
Which resource is used to look up benefit information for a member that has a company plan (rather than an individual plan).
Plan Sponsor Tool
Facility Claims are typically billed on what type of claim form?
UB04
Claims can be submitted by what two methods?
Electronically or by paper
Institutional, Professional, and Dental
What icon opens the claim for edit in HRP?
Pencil
What is a resource that was developed to help processors with the steps not discussed in e.Policies?
Claim Resource Tool
What does HRP Auto Adjudication (AA) mean?
When HRP handles the claim without any manual intervention.
True or False, paper claims can only be keyed in manually?
False, paper claims can also be scanned in via the Optical Character Recognition (OCR) process. Where they too will receive an “E-ID”.
What claim status means the claim has been flagged for review during the data validation process. A claim can be flagged for review for many reasons. Example: An authorization is required by HRP, but HRP was not able to locate one.
Need Review Status
Audit Log
What resource releases information before it is updated in e.Policies?
System Communications
When claims drop from Auto Adjudication, they are assigned what to help the processor resolve the claim?
Trigger
What two applications can be used to look for paper documents that have been received?
ECHS and IOPView
When a processor comes in to work a claim, which option will they choose in general in HRP to find the workbasket which they will work?
Claims Review and Repair
What icon in HRP Manager allows you to do a quick search, takes you straight to what you are looking for.
Eyeball
The Quality Team uses which two resources to determine if a claim has been handled properly?
e.Policies and System Communications
What claim form is typically used for billing professional claim services?
CMS/HCFA1500
What is the number referred to as when a document when it is received?
Scan code/DCN
After locating a claim we are going to work, what is our next step?
Open for Edit
In the members file what tab would I select to look at anything that has a limit, ex. Routine eye exam
Accumulators
System Communications should be reviewed how often?
As soon as they are received
As a Claim Benefit Specialist what is your main function in the billing process?
Handle claims that fall out of the Auto Adjudication process/handle any triggers on a claim based on workflows in policy.
Which website allows you to look up Diagnosis, Treatment, Modifiers and reference materials all in one place?
Flashcode
True or False, we are required to document a note in each claim we handle?
True
What tab on a claim would show us what services are being billed?
Lines