Assessment
Introduction to ClaimsSure
By the end of this course, you will understand
? What ClaimsSure is and how it is useful
? How improper billing is detected
? The four factor that predict anomalies in billing
? ClaimsSure scenarios
? ClaimsSure flow.
Overriding Member Data: An Overview
This module will define member date override, explain the purpose of overriding member data, and use an illustration to explain the process of overriding member data.
Managed Care Rate Factors: An Overview
This module will define MC rate factors and also explain why only the base rate factor needs to be added for PRISM.
Managed Care Contracts: An Overview
This module will explain the purpose of an MC Contract. It will also describe the steps to set up an MC Contract by using an illustration.
Contracts Management Process: An Overview
This module will provide an overview of the Contract Management process with an illustration. It will also describe the stages in the Contracts Management process. The module will also introduce the entities who are involved in the process.
Claims Resolution: An Overview
In this module, you will be introduced to the Resolution function of Claims and Encounters. You will also learn about the different concepts such as error types, error dispositions, and release and refer functions that are associated with suspended claims.