Claim Edit WQs Flashcards
Where are type 3 edits plugged in to?
CDF
True or False: Type 3 edits force claims into the error pool
True
True or False: Error codes are routed to user/wq to be fixed
True
True or False: By attaching one or more rules to queue you define which errored claims a wq can see after claim processing
True
True or False: A single rule can only be used in one WQ
False; a single rule can be used in many wqs
True or False: Within a WQ, there is a OR relationship between rules
True
True or False: Your service should have one queue with no rules attached to allow a supervisor to monitor all of the error claims in a service area-ensuring that all claims are being worked on
True
True or False: Rules determine what piece of the error pool a user sees while the CDF determine what goes to the error pool
True
What does the customize view used to see?
Used to update columns that appear in a claim edit wq and their widths, names, and order
What does the batch scheduler ?
Can help you maintain up to date claim edit wqs by testing claims automatically.
What does the MSA WQ Auto Release Template #1151 do?
This job will rerun claims through edit checks (based on the cdf) and automatically release claims from the WQs that no longer have errors
What does the Non-Qualified Release Template #1156 do?
Will re-run claims and automatically release claims from the WQ in which the claim is no longer valid. AKA “Claims Sweeper”. (such as voided claims)
This template affects non-CEV claims. Template #1151 performs this functionality for VEC claims.
True or False: The auto-release job should run before the claim sweeper
True
Security for Resolute (Claims) consists of what 3 components?
User security
Security Class
User Role
Professional Billing security classes are composed of what two parts?
Modules
Security points
What does a module represent?
A module represents and gives access to, a large piece of functionality of PB. In order to see that functionality the user must be assigned a PB security class (70% of activity for the user)
What does security points represent?
Used to control access to specific pieces of functionality within modules.
What are the two types of security points and what do they do?
Permissive: Start with “May” and what the user may perform
Restrictive: Do no begin with “May” They take away a user’s access to functionality that module security otherwise DOES give
True or False: Overriding individual errors removes only the individual error from the claim
True
True or False: When the overridden error is resubmitted, it is compared to all master file and user error checks EXCEPT for the overridden error
True
The security to override claim errors can be turned on at what following locations:/areas:
Turned on the service area/facility level
Security point 223
True or False: When rejecting a claim the claim’s charge retains their balance and their claim status becomes N/A. They are not considered for future claims until a Resubmit or Next Responsible party action places them back on the claims processing queue.
True
Also—security for this only for security point 226-may reject claims from claim edit wq
True or False: A rule attached to a claim edit wq errors out claims into the error pool
False, it determines which WQ the error goes to. The CDF determines if the claim errors out or not.
In which WQ should the auto-release box be checked to?
The No Rules Claim Edit WQ
