Claim Forms

Question 1

Define CEV forms and how they are used?

Answer 1

CEV forms are ABF and EDF forms that are modified to enable use of claim edit values. The forms have an additional layer of claim processing logic which allows much greater flexibility and power when overriding portions of a claim.
CEV forms use claim form item override rule that can be plugged in to both paper and electronic claim forms

Question 2

What screen defines what information is pulled onto the claim form and in what circumstances as well as where each piece of information is placed on the page and how it is formatted

Answer 2

Item Specification Screen

Question 3

The Claim Values lists what?

Answer 3

All the data to be produced on the claim form

Question 4

What screen allows particular values on the claim form to be overridden?

Answer 4

Value override screen

Question 5

What screen allows groups of information on the claim form to be overridden?

Answer 5

Group Overrides screen

Question 6

True or False: ANSI format has a header and trailer to indicate the start and end of a file.

Answer 6

True

Question 7

The ANSI 837 file is comprised of what four major parts?

Answer 7

Loops: Series of segments defined to provide a specific type of data. (ie: information about the billing provider

Segments: a line of data within a loop defined to provide specific information (the billing provider’s name)

Elements: a segment is made up of elements (provider’s last name)

Delimiters: Used to separate segments and elements

Question 8

True or False: Tree definition screen holds delimiters

Answer 8

True

Question 9

True or False: The profile variable combined with its value and the service area; will be used to determine the data to print in the various loops of the ANSI electronic claim

Answer 9

True

Question 10

True or False: Non-CEV Claim forms modifications can be used via claim overrides for both electronic and paper forms.

Answer 10

False.
Modification can be made using Virtual Items for Paper forms and Printing overrides for electronic forms.
Also, the compile step has to be compile before testing

Question 11

True or false: CEV forms modifications can be made by using Claim Form Overrides, for both paper and electronic forms.

Answer 11

True, as well as the compile step done automatically when the form record is closed in Hyperspace.

Question 12

True or false: Default claim form can be overridden in the CDF based on certain specific situations

Answer 12

True

Question 13

What are the four places that claims can be sent by default?

Answer 13

Payor address
Coverage address
Plan address
Account address

Question 14

The four addressing options for claims can be set at what field?

Answer 14

The Claim Mail Code.

Which indicates where the claims should be sent by default for this payer

Question 15

True or False: The default claim mail code is a one time default.

Answer 15

True
If the default mail code in the benefit plan or payor master file is changed, existing coverages using that plan or payor are not updated. The new value appears by default only in coverages you create in the future

Question 16

At the service area level, claims can be set to split by for two different reason. What are they?

Answer 16

Visit and Department

Question 17

List a few automatic splits for claims

Answer 17

By Rev location
By Place of Service
By Provider ID
By Department
By Plan
By Coverage ID

Question 18

In the CDF settings it is only possible to submit, resubmit, or demand 0.00 charges?

Answer 18

Submit.

Question 19

Claim forms can be defined at which of the following Levels: (list all that apply)
a Payor
b Plan
c service area 
d CDF

Answer 19

Payor/Plan/CDF

Question 20

Name three ways to split a single visit onto two or moer forms using ONLY the payor master file

Answer 20

Department
Location
POS

Question 21

If the service area IS NOT set to print one department per form and the payor master file IS set to print one department per form, will the visit for that payor be split if two departments are on the same encounter?

Answer 21

Yes, the visit will be split by department

Question 22

True or False: Claims balances below a set amount will be written off when the statements are processed

Answer 22

False; the balances will be written off when the claims are processed.

Question 23

Can the claim sort order be at the payor level, the CDF level, or Both?

Answer 23

Both