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When logging into HRP, you should use what server to get into HRP- Live/Production environment?
What is PROD (HE) or PROD(HUMANA)
A practitioner is searchable by this ID number?
NPI
If a member's plan has an end date year of 3000, what does that mean?
The member's plan is currently active
To view totals for the entire claim, which tab should be clicked?
Header
**BONUS- 200 PT
What CPT code is used to replace all existing codes during claim modification?
99499
On the HRP toolbar, what are the back and forward arrows used for?
Step backward / forward to documents viewed in the HealthRules Manager page during your current session.
Where must you click to find network details for a practitioner?
Roles
What tab within the member profile shows a list of claims received for the member?
Claims
To find an itemized list of services completed within the claim, where should you look?
Lines
For claim modifications- where do you paste the claim #?
Ext. Cross reference claim number field
On the HRP toolbar- what is the pencil used for?
Edit the record you are currently viewing.
All payments are available at the ___________ level.
Supplier
When in a member profile, where can you view a member's eligibility info? BONUS 300PTS if you can show how to get here
Benefit Plans
Name any 3 claim status types
Needs Repair
Needs Review
Needs Repricing
Rejected
Denied
Final
Consolidated
Waiting for External System
What is the HCC amount?
The HCC Amount field represents HealthCare Company amount.
For capitated claims, it represents what would have been paid for the claim if it was not capitated.
HCC Amount If the service is not capitated, the HCC amount and the Paid Amount are the same.
What are the proper steps to close out of the HRP application?
File> Exit
tax id
To find what networks a member is apart of, where do you start within the member profile?
Benefit Plans
What section of the Lines tab shows what benefit a service paid towards?
Benefit Adjudication Details
To find the reason for denial, what code should you review?
User Message
What is the magnifying glass used for? Name 3 results you may get by using this tool
Open search page, which lets you search documents using a variety of filters. You can search by claims, members, providers, etc.
What tab houses Practitioner/ Supplier specialties?
General
To find notes and processing timestamps on a member profile where should you look?
Audit trial
What field identifies when the claim was most recently processed?
Last changed on
If you are viewing the contracts for a provider, what should you click for additional details?
External Rules