Legal Liability
The location of the ACTIVITY_WORK_JOB
What is /home/ted/apps/activityWork/*
A unique identifier for a check
What is a Control Number?
After pulling claim numbers from CHAMPS, the Buy-In system updates claim numbers from its eligibility system if it follows these two rules
What is it is a railroad claim and the numerical portion of the claim number is 6 or 9 digits long.
Where all extraction rules are stored
What is Configurable Rules or Extraction Maintenance
This process pulls crash information from the Michigan Traffic Crash Reporting System (TCRS) database to match with members and claims with the eventual goal of creating casualty cases that workers can use to find Medicaid paid claims that should have been covered by automobile insurance.
What is the CRASH process?
One of the fields that display in the Commercial information section when an accident is related to a commercial vehicle
What is:
Carrier Name
Carrier Street
Carrier City
Carrier State
Carrier Zip
Carrier Name Source Code
Commercial Truck Key
Gross Vehicle Weight Rating
This code informs the State that the individual was accreted to the State's buy-in account
What is code 11?
This extraction applies to Medicare Part D encounters managed care plans that are expected to be pursued for recovery
What is Encounter Medicare Part D?
TED interfaces with the State of Michigan Workers' Compensation Agency to receive and import case, claims, and reference information. Once imported, the information in the file is used to do something.
What is to match cases and claims to records in the MMIS that have been paid by the state in order to pursue potential recoveries?
On the Claims tab, this property is displayed in bold when the claim type is managed care payment
What is the provider name
This job receives incoming CMS files and inserts them into the application database, then processes the imported records to create members, update information, tag records, create work items, etc.
What is the CMS Import job?
The unique MMIS identifier for the claim
What is TCN (Transaction Control Number)?
A case that is not tied to a Medicaid member
What is a Subject-based case?
This tab of the Check Tabs section tracks activity on the check, including classification, when the check was closed or reopened, and a snapshot of cashiering system activity if there is an interface available
What is the Accounting Tab?
This criteria is used to determine when to update our member record to use the Active Medicare Claim Number from the CMS import record
What is:
1. Record Identification Code (RIC) is C
2. The Medicare Claim Number on the member record does not match the Active Medicare Claim Number on the import record
This tab in Extraction Maintenance stores claim types that are excluded from specific extraction processes
What is the Claim Exclusion Rules tab?
Michigan's eligibility system that is viewable in the Eligibility Data Warehouse Information section
What is Bridges
This tab only appears if the check pertains to a Legal Liability Case Management case
What is the Case tab?
This code is sent by Buy-In upon confirmation from CMS that Part A Buy-In can be done
What is Code 44 - Disabled Adult Children (Part A & B)
The type of rejection codes listed in the RX OI Rejection Code table that TPL has identified as those in which a recovery can be made if the other insurance is valid
What are National Council for Prescription Drug Programs (NCPDP) rejection codes?