Week one overview PDR

true or false ( a professional claims are claims submitted for services rendered by the (rendering provider)

• true

• false

which claim, form is used for professional claims?

• CMS1500

• UB04

what are the 3 parts to a queue code?

• UNIT

• Function

• Queue

• Statues

which type of profile in WGS do I want to use when I am researching a claim?

• Claim Inquiry

• Live

• adjustment

which claim profile do I want to use if I am ready to process claim?

• Claims Inquiry

• live

• adjustment

which pop up can I use to look up specialty of provider/additional modifier codes/and tell me pricing state

• Text (TX)

• Data Support (DS)

• Claims X-ten (CX)

• Provider data (PD)

what color are my pops up in WGS?

• blue

• red

• black

• yellow

If a member deductible is embedded we look at which deductible to determine if it was met?

• Indivual

• Family

• BOTH

If deductible is NON embedded we look at only the _____ to see if it has been met?

• Induvial

• Family

• BOTH

when looking at accumulators for deductible and OOP for legacy claims, look at the buckets that start with Totals. (true or false)

• true

• false