Using Claim Reconciliation

Question 1

With claims reconciliation you can import claim status files to allow two basic things; which are?

Answer 1

Reconciliation: Were your claim files transmitted to the clearinghouse and/or the payor entirely?
Status updates; How are the claims doing?
Are they accepted, denied, awaiting for a payment, or rejected by the payor?

Question 2

True or false: If a claim is already accepted, status messages can be used to route rejections to f/u wqs prior to resolving a denial or record information on the whereabouts of a claim

Answer 2

True

Question 3

The claim status files comes into 2 main flavors; which are what?

Answer 3

A delimited flat file
or
ANSI 277
(Generally clearinghouses send a delimitedflat file, while payors send ANSI 277)
ANSI 277 is specially formatted delimited flat file.

Question 4

True or False: Automatic actions during CRD process are driven by status codes contained in the file

Answer 4

True
For claims that have status of processed, these codes can cause the system to accept the claims or route the claims to a claim edit WQ.

Question 5

True or False: During CRD if the file that contains status information for accepted claims currently located in a f/u wq, this information will be recorded on the f/u records and can trigger them to route to different follow up wqs

Answer 5

True.

Question 6

What can be done automatically by the system based on the information received in a claim reconciliation file?

Answer 6

accept clean claims
send error claims to the error pool to be worked on in claim edit wqs
marked records in follow up wq (which can cause them to be re-routed, or other automatic activities