adjustments

If you identify that your adjusted claim is paying the same as original claim paid, what adjustment type is that?

• Supplemental

• Statistical

• Automated

• Overpayment

If your identify that your adjusted claim is paying more then the original claim paid, what adjustment type is that?

• Supplemental

• Statistical

• Automated

• Overpayment

If your identify that your adjusted claim is paying less as the original claim paid, what adjustment type is that?

• Supplemental

• Statistical

• Automated

• Overpayment

For a corrected claim adjustment, do we need to create an inquiry and route to recovery team if you identified that your adjusted claim is paying less then what we paid on the original claim by $5?

• No

• yes

• only complete inquiry do not route

How many digits is the adjustment reason code?

• 2

• 3

• 4

• 5

what type of adjusted claim scenario is this? " we received an inquiry from provider requesting to re-process/review a claim that was Finalized/processed, claim adjudicator identified the claim was processed incorrectly and will have to initiate an adjustment to re-process claim"

• Corrected claim Adjustment

• Simple Adjustment

what type of adjusted claim scenario is this? "we received a corrected CMS-1500 claim form from a provider to fix information he had previously billed on another claim. That corrected claim is assigned to a claim adjudicator to fix information on claim and re-process"

• Corrected claim Adjustment

• Simple Adjustment

True or False, You Can initiate an adjustment on claim that is not in 99 statues

• true

• false

what system on the floor will you use to initiate adjustment?

• CI&W

• WGS

• FOB

What things below do you need to know before you can initiate adjustment?

• Adjustment reason code

• Unit number

• MLH Number

• The DCN of the claim to be adjusted