In this module, you will be introduced to the different entities involved in claims and encounters. You will also understand the role played by each of the entities in the processing and administration of claims and identify the important user profiles that are associated with these entities.
Introduction to Claimsure
In this module, you will be introduced to the components of the Claims and Encounter subsystem of PRISM and identify the role of each of the components in claims processing. You will also identify the adjudication process and learn about the integration of the Claims and Encounter subsystem with other PRISM subsystems such as Contracts Management, Provider, and Benefits Administration.
Claims and Encounters Inquiry: An Overview
In this module, you will be introduced to the Claims Inquiry function of the Claims and Encounters subsystem. You will also identify the different Show menu items that you can use to view the various details of the online claims and encounters and the generated and/or paid MCO transactions.