Claim Tab
This window provides the claim general information and all the details surrounding a specific claim. (Go over fields, pop outs, hyperlinks)
What is the Claim Header Subtab.
The Pay tab defaults to this subtab, which provides line level payment information.
What is the Claim Pricing Details subtab.
The top of which window provides a running total of how many adjudication attempts have occurred?
What is the Edit Details window.
This subtab displays the details of the primary carrier’s dispensation of the claim, including allowed, payment, and member cost share amounts.
What is the COB Claim Details subtab.
This subtab displays the original claim high-level information and all adjustments or reversals performed on this particular claim over its history.
What is the Adjustment History subtab.
This window displays information found in the service lines on the claim.
What is the Service Line Subtab.
This subtab provides a medium to store memos pertinent to the processing of claims, such as a provider pay hold.
What is the Memos subtab.
This window provides a systematic look at how the system processes a claim using State business rules and provides an extremely useful tool to understand, research, and audit claims adjudication.
What is the Step Edit window.
This is a claim extension that determines which COB enrollment is the correct one to pay the claim.
When a claim enters the system via the EDI method, the _________ subtab provides process log information for claim investigation
What is the Processing Details subtab.
This window displays information billed on 1500 and UB04 claims regarding the attending, operating, referring, or other providers.
What is Providers Subtab.
This is a user-defined field that tracks customer information.
What is a claim attribute.
This subtab displays the rate code and coverage code from the member’s eligibility.
What is the Enroll Coverage Audit subtab.
This table includes the consolidated payment and information regarding the COB.
What is the COB Totals table.
The GPCS subtab defaults to a GPCS Details window, which displays an input and output ____ tab.
What is JSON.
The EVV subtab displays the occurrence of authorized personal attendant service visits by electronically documenting the precise time a service delivery visit begins and ends. This information displays for the selected line.
What is the Check In Date and Time and Check Out Date and Time.
This subtab displays limits and maximums reached or applied on the current claim. Limits are listed per service line.
What is the Limits subtab.
This subtab contains adjudication history data.
What is the Edit History subtab.
This contains other carrier information the member might be enrolled in.
What is the Claim Other COB Enrollment section.
This is a software component that is integrated with Administrator to ensure that code and claim editing rules are accurate and consistent with standard business practices.
What is ClaimXten.
If a claim has not been through adjudication, you would also see which button on the Edit Claim subtab?
What is the HOLD/RELEASE button.
This is where a claim analyst would come after doing research on a claim and add or remove pricing manually.
What is the Claim Pricing Detail subtab.
This is a set of Structured Query Language (SQL) statements with an assigned name. Additional claim review against custom coding/product enhancements.
What is Claim Extensions.
The COB Totals table includes COB _________ details, which includes the total allowed amount, the total paid amount, and many other details about the COB.
What is the COB Processing Details section.
Under the ClaimsXten subtab, there are four addtional subtabs. Name them.
What are details, claim history, input XML, and output XML.