Assessment
Medicaid
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.
In this module, you will be introduced to the different types of claims and identify the characteristic of each claim type.
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.
Assessment
In this module, you will be introduced to the managed care Gross Adjustment process. You will also learn about the header and line level adjustment transaction details, account code generation for the line level transactions, and the approval process for MC Gross Adjustment transaction.
In this module, you will learn about the functions of the TPL subsystem and how the Member subsystem interacts with TPL.
In this module, you will learn about UPP and identify the beneficiaries of UPP. You will also learn how UPP works.