Jeopardy!

Medical Claims in Facets

100

One of the first steps when searching for a claim; You want to make sure this field/box is cleared. 

Provider ID

200

You only want to quote a claim with this status. 

02. Completed 

300

Data tree that has payment information 

Payee Remit Detail 

400

This tab in the back end of Facets has indicators to help research the claims processing logic. 

Clinical Edits Tab 

500

This tab in the back end of Facets has information left behind from claims adjustors that can be beneficial to understanding the claims processing logic. 

Notes Tab 

Cool Tools

100

This site allows you to put in the claim number and explain its processing in "English". 

PDAT

200

This application is our internal "mail" to other departments but can also be used to see claim images. 

Macess

300

You'll visit this site if you cannot find a claim in facets. 

ECHO

400

Located in APRIL, this tool can be used to look up claim mailing address, claim payor IDs, appeals mailing address, and appeal fax numbers. 

Provider Resource Tool 

500

Search PIQ ticket numbers with this tool. 

Optum Cloud Portal 

Gimme some more Facets!

100

Term used to describe the agreed amount or maximum reimbursement a provider can receive for services. 

Allowed Amount 

200

Copayment, Coinsurance and Dedictuble are all examples of this 

Cost share

300

This tab in the back end of Facets will show the processing of another insurance if applicable. 

COB Tab 

400

This unique number sequence refers to an EFT payment and also can be used to generate a EOB/PRA

Payment Ref ID

500

You can determine if a claim processed INN or OON in this data tree 

Claim Data 

Recon VS Appeal

100

Macess ticket numbers always start with 

SF 

200

Medicaid and PA DSNP appeals are stored in this site 

ETS

300

DSNP and OH MMP appeals are stored in this site 

ATS 

400

If reconsiderations are step 1 out 2, what would be step 2? 

Appeals

500

When an appeal is redirected it mean it has become what?

Reconsideration 

Just for fun :)

100

This site is UHC's main hub where you can view benefits, record your time worked, launch learning courses etc. 

Sparq

200

Our graduation date 

March 29th 

300

This location is nicknamed the Sunshine State 

Florida 

400

This state has a city also referred to as "The Chocolate Capital of the World". 

Pennsylvania 

500

Tina's newest edition is named after what delicious dessert.

Brownie