EPIC RHB 330 QUESTIONS AND VERIFIED ANSWERS
For processing multiple claims at once you can use _________ or the ______________
- Answers - the claims processing functionality in Hyperspace or the batch scheduler
template
The Claim Definition File (CDF) does the following - Answers - - Error Checking
- Claim edits
- Defines Claim Splitting Scenario
- Defines Claim Form and Claim Medium to use
- Other claims formatting
Print forms allows you to generate the claims both _______ and _________ - Answers -
Paper and Electronic
When troubleshooting, you may need to use the _______ section to look up the CDF or
claim form - Answers - System section
Claim runs are typically created using the _______ _______ - Answers - Batch
Scheduler
-This allows the runs to be created automatically during a regularly scheduled time
Batch Scheduler Recommendations - Answers - - HB Nightly Processing and HB Claim
Run batch jobs can be run concurrently
- HB Claims testing job should be run prior to the HB Claims Jobs(s)
- Never allow the claim run batch job to Aut0-Accept claim runs
41004 - HB Claims Testing
The HB Claims testing template looks at all of the claims currently in the _______
______ and runs the claim edit checks. - Answers - Error Pool
This finds and clears:
- Master file errors that have been corrected
- User errors that weren't corrected through the Claim Edit activity, but are resolved now
- User errors that were corrected in Claim Edit but for which the refresh button was not
clicked
41002 - HB Claim Run
Use the HB Claim Run batch job template to handle the entire _______ _______
process - Answers - Claim Production
When an ad-hoc claim needs to be produced outside of automated scheduled claim
runs, individual claims can be created from the _______ ________ - Answers - Hospital
Account
,Cancel claims let the payer know that.... - Answers - you are canceling a previously sent
claim
What are the 3 ways to produce a claim from the Hospital Account - Answers - -
Demand
- Resubmit
- Create a cancel claim
Demand claims can only be printed for insurance buckets that are: - Answers - - On a
hospital account that passes DNB checks and is in a Billed Status
- Not on a current claim
- Not on an error run
Demand Claims do not allow ________ - Answers - splits
If a liability bucket generates ________ _______, an error message is displayed and
the demand claim is not processed - Answers - multiple claims
The Demand Claim Processing window allows you to change/edit what kind of
information? - Answers - - Claim Form
- Account Class
- Type of Bill
- Include select claim lines only
By default, the system will select the option to use the data from the previous claim
when generating a new claim
What is a Type of Bill (TOB)? - Answers - A Type of Bill (TOB) code is a three-digit code
used on claim forms to specify the type of bill being submitted to a payer,
These codes help ensure that that claims are being processed correctly and that the
payer understands the context of the services provided
TOB Indicators - Answers - - 1st digit indicates the type of facility such as 1 for hospital
or 2 for SNF
-2nd digit represents the base class such as 1 for IP or 3 for OP
- 3rd digit describes the claim such as 7 for replacement claims or 8 for cancel claims
Ex. 137 is a Hospital Outpatient replacement of prior claim
What happens when you select the include claim lines only checkbox for a liability
bucket? - Answers - - the claim lines button is enabled
- here you can you can modify the information on the previous or current claim prior to
creating a new one
Page 35-36
, What happens if the demand claim fails any edit checks or splits during processing? -
Answers - - errors or split messages are displayed
- a user can choose to print the claim anyway or send to the error pool
Resubmitting a claim sends the claim back to the claims queue to be produced
________ by a batch job - Answers - overnight
True or False. You can change the claim form using resubmit claim - Answers - - False
You can only change the claim form using demand claim
Demand Claim - Answers - - Prints Claim immediately
- Can override claim
- Can override Type of Bill (TOB)
- Can override Claim Lines
- Is evaluated by the CDF
Resubmit Claim - Answers - - Prints Claim Overnight
- CANNOT override Claim Form
- Can override Type of Bill (TOB)
- Can override Claim Lines
- Is evaluated by the CDF
Cancel claims are created when the initial claim was sent with _________ information -
Answers - incorrect
If a payment has already been received the ____ number is also included with a cancel
claim - Answers - ICN
Cancel claims can be created even if the _____ has already been _______. This allows
billers to go back and send the cancel claim if they have previously forgotten. - Answers
- bucket
rejected
True or False:
Demanding a claim always creates an electronic claim. - Answers - False
Demanding a claim always creates a paper claim
True or False:
A cancel claim erases the previously created claim on an account. - Answers - False.
Cancel claim produces a claim to tell the payer to ignore a previously sent claim
True or False.
When you demand a claim, it is evaluated by the CDF. - Answers - True.
But you may choose to print even if there are errors
For processing multiple claims at once you can use _________ or the ______________
- Answers - the claims processing functionality in Hyperspace or the batch scheduler
template
The Claim Definition File (CDF) does the following - Answers - - Error Checking
- Claim edits
- Defines Claim Splitting Scenario
- Defines Claim Form and Claim Medium to use
- Other claims formatting
Print forms allows you to generate the claims both _______ and _________ - Answers -
Paper and Electronic
When troubleshooting, you may need to use the _______ section to look up the CDF or
claim form - Answers - System section
Claim runs are typically created using the _______ _______ - Answers - Batch
Scheduler
-This allows the runs to be created automatically during a regularly scheduled time
Batch Scheduler Recommendations - Answers - - HB Nightly Processing and HB Claim
Run batch jobs can be run concurrently
- HB Claims testing job should be run prior to the HB Claims Jobs(s)
- Never allow the claim run batch job to Aut0-Accept claim runs
41004 - HB Claims Testing
The HB Claims testing template looks at all of the claims currently in the _______
______ and runs the claim edit checks. - Answers - Error Pool
This finds and clears:
- Master file errors that have been corrected
- User errors that weren't corrected through the Claim Edit activity, but are resolved now
- User errors that were corrected in Claim Edit but for which the refresh button was not
clicked
41002 - HB Claim Run
Use the HB Claim Run batch job template to handle the entire _______ _______
process - Answers - Claim Production
When an ad-hoc claim needs to be produced outside of automated scheduled claim
runs, individual claims can be created from the _______ ________ - Answers - Hospital
Account
,Cancel claims let the payer know that.... - Answers - you are canceling a previously sent
claim
What are the 3 ways to produce a claim from the Hospital Account - Answers - -
Demand
- Resubmit
- Create a cancel claim
Demand claims can only be printed for insurance buckets that are: - Answers - - On a
hospital account that passes DNB checks and is in a Billed Status
- Not on a current claim
- Not on an error run
Demand Claims do not allow ________ - Answers - splits
If a liability bucket generates ________ _______, an error message is displayed and
the demand claim is not processed - Answers - multiple claims
The Demand Claim Processing window allows you to change/edit what kind of
information? - Answers - - Claim Form
- Account Class
- Type of Bill
- Include select claim lines only
By default, the system will select the option to use the data from the previous claim
when generating a new claim
What is a Type of Bill (TOB)? - Answers - A Type of Bill (TOB) code is a three-digit code
used on claim forms to specify the type of bill being submitted to a payer,
These codes help ensure that that claims are being processed correctly and that the
payer understands the context of the services provided
TOB Indicators - Answers - - 1st digit indicates the type of facility such as 1 for hospital
or 2 for SNF
-2nd digit represents the base class such as 1 for IP or 3 for OP
- 3rd digit describes the claim such as 7 for replacement claims or 8 for cancel claims
Ex. 137 is a Hospital Outpatient replacement of prior claim
What happens when you select the include claim lines only checkbox for a liability
bucket? - Answers - - the claim lines button is enabled
- here you can you can modify the information on the previous or current claim prior to
creating a new one
Page 35-36
, What happens if the demand claim fails any edit checks or splits during processing? -
Answers - - errors or split messages are displayed
- a user can choose to print the claim anyway or send to the error pool
Resubmitting a claim sends the claim back to the claims queue to be produced
________ by a batch job - Answers - overnight
True or False. You can change the claim form using resubmit claim - Answers - - False
You can only change the claim form using demand claim
Demand Claim - Answers - - Prints Claim immediately
- Can override claim
- Can override Type of Bill (TOB)
- Can override Claim Lines
- Is evaluated by the CDF
Resubmit Claim - Answers - - Prints Claim Overnight
- CANNOT override Claim Form
- Can override Type of Bill (TOB)
- Can override Claim Lines
- Is evaluated by the CDF
Cancel claims are created when the initial claim was sent with _________ information -
Answers - incorrect
If a payment has already been received the ____ number is also included with a cancel
claim - Answers - ICN
Cancel claims can be created even if the _____ has already been _______. This allows
billers to go back and send the cancel claim if they have previously forgotten. - Answers
- bucket
rejected
True or False:
Demanding a claim always creates an electronic claim. - Answers - False
Demanding a claim always creates a paper claim
True or False:
A cancel claim erases the previously created claim on an account. - Answers - False.
Cancel claim produces a claim to tell the payer to ignore a previously sent claim
True or False.
When you demand a claim, it is evaluated by the CDF. - Answers - True.
But you may choose to print even if there are errors
