In this module, you will learn about adjustment, voiding, and reprocessing of claim transactions by providers and State users. You will also learn about the mass adjustment and Gross Adjustment functions in the Claims and Encounters susbystem.
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.
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 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 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.
Member Communication: An Overview
In this module, you will identify why member communication is important for Medicaid. You will also identify the use of alternate correspondence address and the process to capture member communication details.
Viewing Member Communication Details
In this module, you will learn how to view member communication details.
Adding Member Communication Details
In this module, you will learn how to add member communication details.
Searching the Eligibility Details of a Member
In this module, you will learn how to search the Medicaid eligibility of a member. You will also identify various filter types and key functions available in the eligibility list page.
Viewing Eligibility Details of a Member
In this module, you will learn how to view the eligibility details of an enrolled member. These eligibility details include relationship details, benefit plan history, eligibility history, patient pay amount history, restriction details, third party liability details, and RAC details.