All About the Money
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)?
This is a formal process used when a reconsideration has been denied or when the claimant disagrees with the outcome of the reconsideration.
What is an appeal?
This system is used to view notes from a provider call.
What is Gainwell Workspaces?
These help you mark emails that need follow-up, so you don't forget to respond or take action later.
What are flags?
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?
On this sub-tab under the Claim tab in VUE360, you can see a list of all the services provided with service codes and brief descriptions.
What is Service Line?
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?
You can run a Remittance Advice Report in VUE360 here.
Where is Supporting Systems-->SSRS Reporting?
This field on a claim advises how the claim was submitted to DC Medicaid.
What is Claim Source?
This suffix indicates the first adjustment to claim.
What is A1?
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?
In The Well, you can use Contribution Types, Content, Contributors, and Groups to do this to your search results.
What is filter?
The Claims and Finance Teams will receive escalations via a notification in this system.
What is Verint?