Claim Edit WQs

Question 1

Where are type 3 edits plugged in to?

Answer 1

CDF

Question 2

True or False: Type 3 edits force claims into the error pool

Answer 2

True

Question 3

True or False: Error codes are routed to user/wq to be fixed

Answer 3

True

Question 4

True or False: By attaching one or more rules to queue you define which errored claims a wq can see after claim processing

Answer 4

True

Question 5

True or False: A single rule can only be used in one WQ

Answer 5

False; a single rule can be used in many wqs

Question 6

True or False: Within a WQ, there is a OR relationship between rules

Answer 6

True

Question 7

True or False: Your service should have one queue with no rules attached to allow a supervisor to monitor all of the error claims in a service area-ensuring that all claims are being worked on

Answer 7

True

Question 8

True or False: Rules determine what piece of the error pool a user sees while the CDF determine what goes to the error pool

Answer 8

True

Question 9

What does the customize view used to see?

Answer 9

Used to update columns that appear in a claim edit wq and their widths, names, and order

Question 10

What does the batch scheduler ?

Answer 10

Can help you maintain up to date claim edit wqs by testing claims automatically.

Question 11

What does the MSA WQ Auto Release Template #1151 do?

Answer 11

This job will rerun claims through edit checks (based on the cdf) and automatically release claims from the WQs that no longer have errors

Question 12

What does the Non-Qualified Release Template #1156 do?

Answer 12

Will re-run claims and automatically release claims from the WQ in which the claim is no longer valid. AKA “Claims Sweeper”. (such as voided claims)
This template affects non-CEV claims. Template #1151 performs this functionality for VEC claims.

Question 13

True or False: The auto-release job should run before the claim sweeper

Answer 13

True

Question 14

Security for Resolute (Claims) consists of what 3 components?

Answer 14

User security
Security Class
User Role

Question 15

Professional Billing security classes are composed of what two parts?

Answer 15

Modules

Security points

Question 16

What does a module represent?

Answer 16

A module represents and gives access to, a large piece of functionality of PB. In order to see that functionality the user must be assigned a PB security class (70% of activity for the user)

Question 17

What does security points represent?

Answer 17

Used to control access to specific pieces of functionality within modules.

Question 18

What are the two types of security points and what do they do?

Answer 18

Permissive: Start with “May” and what the user may perform

Restrictive: Do no begin with “May” They take away a user’s access to functionality that module security otherwise DOES give

Question 19

True or False: Overriding individual errors removes only the individual error from the claim

Answer 19

True

Question 20

True or False: When the overridden error is resubmitted, it is compared to all master file and user error checks EXCEPT for the overridden error

Answer 20

True

Question 21

The security to override claim errors can be turned on at what following locations:/areas:

Answer 21

Turned on the service area/facility level

Security point 223

Question 22

True or False: When rejecting a claim the claim’s charge retains their balance and their claim status becomes N/A. They are not considered for future claims until a Resubmit or Next Responsible party action places them back on the claims processing queue.

Answer 22

True

Also—security for this only for security point 226-may reject claims from claim edit wq

Question 23

True or False: A rule attached to a claim edit wq errors out claims into the error pool

Answer 23

False, it determines which WQ the error goes to. The CDF determines if the claim errors out or not.

Question 24

In which WQ should the auto-release box be checked to?

Answer 24

The No Rules Claim Edit WQ