In this module, you will identify the different components of TPL subsystem. You will identify key terms associated with TPL such as, lead, coverage types, payer, and payee.
Introduction to Managed Care Program Enrollments
In this module, you will be introduced to the program enrollment process. You will identify the differences between auto enrollments and manual enrollments. You will also learn about the 834 enrollment feature.
Introduction to Member Eligibility
In this module, you will be introduced to the member eligibility process. You will learn about the Medicaid program member eligibility and the eRep interface.
Introduction to Member Eligibility and Enrollment
In this module, you will be introduced to the components of Member and Third Party Liability (TPL) subsystems of PRISM. You will identify the functions associated with member eligibility and enrollment. You will also identify the integration of the eligibility and enrollment subsystem with other PRISM subsystems such as Contracts Management, Provider, Claims and Encounters, and Benefits Administration.
Introduction to Oracle Financials for Medicaid
This module will describe how Oracle Financials is integrated with PRISM through schedules, batch, and adhoc database to database transfer of financial data. It will also define key functions such as Account Payables, General Ledger, Account Receivables, and Cash Receipts. The module will also list the entities who are involved in Oracle Financials.
Introduction to Provider Reimbursement Information System for Medicaid (PRISM)
In this module you will learn about the benefits, unique features, and functionality of the Provider Reimbursement Information System for Medicaid, abbreviated as PRISM.
Introduction to Member Services-Siebel
This module will introduce you to the Member Services-Siebel subsystem.
Introduction PA Internal Audit
Introduction Prior Authorization Internal Audit
Prior Authorization Internal Audit
In this module you will learn how to:
Create a PA internal audit
Process additional PA audit review
Process the complete training action
PRocess the review completed task