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.
Assessment: Introduction to Claims Inquiry
Assessment
Introduction to Claim Type Determination
In this module, you will learn about the different parameters that help identify Claim Types and the different processes that are employed for determining the Claim Type for Fee-For-Service (FFS) Claims, and Encounters.
Introduction to Claims Administration
In this module, you will learn about the key components of the Claims Administration function. The Claims Administration function allows authorized State users to perform tasks that include maintenance of error codes and alternate dispositions, setting up rules to determine the type of claim, managing Early and Periodic Screening, Diagnostics and Treatment (EPSDT) periodicity schedule, and maintaining remittance advice (RA) banner messages.
Introduction to Admission Records
In this module, you will be introduced to the admission records. You will learn about the methods identified in the Utah Medicaid that are relevant to admission records. You will also learn about the hospice admission process and the nursing facility admission process. You will also identify key roles in the admission records.
Assessment: Introduction to Premium Payments
Assessment
Introduction to Premium Payments
In this module, you will identify the various types of premium payments available in Utah. You will learn how to process the premium payments.