Claims review

When viewing claims in Cirrus, what does chargeable claim mean?

Delegated Arrangement

Assignment of benefits

Stand claim submission

You can have up to 4 modifiers added to procedure codes.

True

False

Under which section will you be able to view an original claim off of a manually adjusted claim?

Service line

Claim service line

Claim line summary

Provider info

If a BA or BOA call on behalf of a member for a claim, what information are you allowed to disclose? Check all that apply.

Payment information

Diagnostic codes and meaning

Check information if available

Member responsibility

Reason for visit

General claim information

Provider TIN

In Cirrus, what is the tab number for claim summary

What are the 2 types of claim forms?

UB-40

CMT 1500

CMS 1500

UB-04

What does the paid amount mean on a claim?

The amount the provider writes off or reduces

The amount the member is paid

The amount UHC/Oxford paid

The amount the provider is charging for the visit

In ACET viewing a claim, what information is available on the claim search page? Check all that apply.

Network

Status Date

Patient responsibility

Provider

Cirrus claim ID number

Status

Tax ID

Primary DX

External claim number

Event type

Encounter

Benefit level shows in provider is INN or OON

True

False

What are our delegated arrangements? Check all that apply?

Evicore

Optum Rx

Orthonet Orthopedic

Optum Healthcare Solutions

Optum Health Transplant Services

Optum Health Physical Health

Optum Health Dental Care

Optum Health Infertility Services

Orthonet Occupational Therapy Services

Before reviewing a claim with a BA or Broker, you must verify the following. Check all that apply

Member's DOB

Member's phone number

Member's status with the group

Permission to speak on the member's behalf

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