Message Codes
User created message code that can be referenced in configuration to route a claim to the review workbasket (error code reasons). Applied during the adjudication process.
What is a CRUM code?
The ability to locate a member by their name, ID, and/or birth date.
What is a member search?
The workbasket listing claims that did not successfully pass through the auto-adjudication process and need to be looked and/or fixed by a claims processor.
What is claim review and repair?
The claim's position after the auto-adjudication process. For example, Final, Denied, Needs Review, Needs Repair, or Rejected.
What is a Claim Status?
Message codes applied to an explanation of benefits (EOB) or correspondence to inform the member/provider of something regarding the claim. (processing policies).
What is a User Message Domain (UMD)?
The date the member's policy became active.
What is an effective date?
The workbasket listing claims that have a status of final or denied that a user needs to edit or review before processing can be completed.
What is Claim Work in Progress?
The location the claim came from prior to ending up in Payor.
What is the Claim Source?
Reasons that can be placed on a Member/Practitioner/Supplier/Account record to send claims to the review workbasket.
What is a Claim Review Reason (CRR)?
The location of the member's previous visits to the dentist, showing the provider they visited, services codes, and the date the service was completed.
What is the claims tab? (Bonus: Show Lines)
This feature allows you to expand your view of a claim and minimize your workbasket.
What is the blue bar?
Either listed as "Statement of Actual Services" or "Pre-Determination."
What is the Transaction Type?
This will tell you if the provider needs to write off something that has been billed for on the claim.
What is supplier responsibility?
The location of where you can search for claims by the tooth number for a specific member.
What is the dental tab?
Some examples include claim ID, owner, group, and review/repair reason.
What are filters?
You can find message codes, member/patient name and ID, and the transaction type on this tab.
What is the Header tab?
This will tell you if the code is a denial or an informational code.
What is an action?
Either active or terminated.
What is member eligibility?
What is Refresh?
You can find the date of service, procedure code, benefit tier, fees, and tooth, surface and oral cavity here.
What is the lines tab?