Across
- 3. A button within the toolbar of a claim that has not auto-adjudicated and is not yet processed to reveal system-identified problems with the claim (i.e. the system may suspect the claim is a dupe. By clicking on the errors button, a message conveying the potential for a dupe is revealed).
- 4. Section of Claim Services where all processed claims are housed.
- 5. The process by which the system attempts to process a claim based on federal laws and regulations, plan rules, and standard billing practices.
- 7. Service area in VBA where claims are processed and can be researched.
- 9. Areas within service areas that houses groups of specific information and functions.
- 13. Service area in VBA where members are managed and can be researched for eligibility and accumulations and ID cards can be requested at the member level.
- 14. A button within the toolbar of an unprocessed claim that can be clicked after all errors have been cleared to fully process the claim and push it towards funding.
- 15. When the user opens a service area, sub-section, or window, a new tab displaying the window's name will appear at the bottom of the application screen. To open another window, users can choose either the Folder tab to return to the main screen or utilize the Services Fly-Out Menu on the right side of the application screen.
- 17. A button within the toolbar of an unprocessed claim that can be clicked after steps have been take to resolve errors to apply edits and attempt to clear the errors.
- 18. The employee.
- 23. Service area in VBA where appeals can be entered. Note: This is not currently used.
- 26. A section in some windows that will reveal different factors about the claim, enrollment record and more.
- 27. Sections of VBA dedicated to specific functions. Service areas work in conjunction with and independent of other service areas.
- 28. A screen that displays specific information and functions.
- 29. Codes used to pend, deny, or provide information about claims. These can be applied by the system or a Claims Examiner.
- 32. A cloud-based claims processing platform.
- 34. A menu on the right of the screen that can be selected to quickly navigate to other service areas and their sub-sections.
- 35. Service area in VBA where copies of network fee schedules and U&C rates can be researched.
- 36. Service area in VBA where authorizations are managed and can be researched.
- 37. Service area in VBA where claims and other work items can be routed to queues for specific people or teams to work on.
Down
- 1. Dependents on the plan.
- 2. Service area in VBA where Case Management manages care plans and can be researched. NOTE: Not currently in use.
- 6. A tool within each window that reveals different functions that can be performed within that area. Note: The toolbar choices will vary depending on what window you are in. For instance, claims that have not been processed will show “adjudicate” and/or “process” while claims that have been processed fully will instead show “adjust.”
- 8. Keyboard combinations that can be selected to quickly navigate to different parts of the VBA.
- 10. Service area in VBA where call notes are taken and can be researched.
- 11. The number assigned to a singular claim within that batch. Note: This type of claim number is assigned before a claim is processed.
- 12. Service area in VBA where letters can be sent and reports can be ran to monitor different factors surrounding processing information and performance.
- 16. The number assigned to a claim after it has been processed. Note: Processed claims will have a batch number, claim number, AND a finalized claim number.
- 19. Section of Claim Services where all unprocessed claims are housed and processed.
- 20. Service area in VBA where providers are added and managed. This area can be researched for network status and provider credentialing.
- 21. The number assigned to a batch of claims that came in or were added to the system at the same time. Note: Batch Numbers are assigned before claims are processed.
- 22. Service area in VBA where benefit codes and plan benefits are managed and can be researched for deductibles and coinsurance rates.
- 24. A section that populates in processed claims that allows you to print letters related to the EOB, Accident Details, and Other Insurance.
- 25. A group of claims that came in or were added to the system at the same time. Each batch can include up to 99 claims.
- 30. Service area in VBA all types of notes can be searched and added. NOTE: Notes can be added in other areas of VBA including Claim Services.
- 31. The process a Claims Examiner undergoes to process a claim that could not be auto-adjudicated.
- 33. Service area in VBA where groups are managed and can be researched for networks, tiers, and U&C percentiles. You can also request ID cards at the group level here.