In this module, you will be introduced to the different types of claims and identify the characteristic of each claim type.
Adding and Updating Domain Criteria for a Claim Type Rule
In this module, you will learn how to add a domain criteria using list. You will also learn how to add a domain criteria using value.
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.
Viewing Claim Type Matrix Rules
In this module, you will learn how to view the Claim Type Matrix Rules.
Viewing Values for Coverage Types
In this module, you will learn how to view the list of valid coverage types using health scope codes.
Accessing and Reviewing Service Types
In this module, you will identify how to access and review member eligibility information in PRISM.
Viewing Program Enrollment Type (PET) Details
In this module, you will learn how to view Program Enrollment Type (PET) details of a member.
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