INTRO TO CLAIM
FACILITY CLAIMS ARE TYPICALLY BILLED ON WHAT TYPE OF FORM
UB04
Claims can be submitted by what two methods?
Electronically or by paper
What claim status means the claim has been flagged for review during the data validation process. A claim can be flagged for review for many reasons. Example: An authorization is required by HRP, but HRP was not able to locate one.
Needs Review Status
What format should a processor use when pulling up a claim in RUMBA-EWM?
C EXXXXXXXX00
(C claimnumber00)
What is the largest organ on the human body?
The skin
DEFINE AUTO ADJUDICATION (AA)
When HRP handles the claim without any manual intervention.
When documents are scanned or submitted my mail, what 2 applications are used to view theses submissions?
ECHS
IOP
What tab on a claim has the notes left by processors and the system?
What 2 pieces of information is need from HRP to verify provider/practitioner participation status in EPDB
EPDB PIN
NETWORK ID
What is the three-digit value that represents pi in math?
3.14
When claims drop from Auto Adjudication, they are assigned what, to help the processor resolve the claim?
Trigger
What tab in HRP will we see the date the claim was received?
HEADER
After locating a claim we are going to work, which icon do you use to work on the claim?
Open for Edit/pencil
What two reference databases/applications can be used to complete a provider search?
RUMBA – EPDB
Smart Front End
Which animal can be seen on the Ferrari logo?
What is a Horse
What claim form is typically used for billing professional claim services?
HCFA 1500
What is the number given to a document when it is received?– the first 6 digits are year, month, and day.
DCN/Document Control Number or Scan Code (according to HRP)
When a processor comes in to work a claim, which option will they choose in the HRP Manager screen to find the workbasket they will process out of?
Claims Review and Repair
Fill in the blanks below:
The ______ ______ tool is used to make changes to the claim. For example, to add denial or informational messages, or edit cost-share and allowed amounts.
Manual Override Tool
The unicorn is the national animal of which country?
Scottland
THE 3 CLAIM TYPES YOU WILL SEE IN HRP
PROFESSIONAL
INSTITUTIONAL
DENTAL
On the INQ1 screen in EWM- what field lets you know if the claim submitted was Professional or Institutional
ENCOUNTER
Fill in the blanks below
______ ______ is used to make changes to the claim such as adding sequestration amounts, or message codes. This should be used as a last resort and documented in claim comments.
Adjust Financials
Fill in the blanks below
Before true participation status of a provider is determined. HRP is set up to check if the claim can be elevated due to _________ or _________
LIBERALIZATION
RAP/HAIRPEN LOGIC
Name that tune
When an old friend I happened to see
I introduced her to my loved one
and while they were dancing my friend stole
my sweetheart from me
Tennessee Waltz - Patti Page