Epic Claims and Remit Practice Test

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• Which specification is used to configure paper claim forms?
• Reason codes and ______ codes are built as _____ records.
• Which type of claim edit workqueue is generally used to monitor the volume of the claims error pool and is not worked by users?
• If a payment from the secondary payer arrives with the primary payer’s invoice number, can you still post the secondary payer’s payment using that same primary invoice number?
• Configuring a ________ relationship allows the invoice payer to be recorded as payer on the payment transaction.
• Which statement about a catch-all claim edit work queue is true?
• In the CDF, which items define the formats used for claims?
• Will the alternate payer be selected automatically in registration, or only the coverage payer is added?
• Use the ____ _____ of the claim to test it against the WQ or rules used in the WQ.
• What is the primary function of a routing rule?
• Which tool updates category cross-reference mappings while managing edits across CDFs?
• What happens to claims that are errored into claim edit work queues?
• If a Claim Edit Workqueue has no rules in it, then what happens?
• What type of override is used to change a single piece of information on a claim?
• Which two actions are automated by batch jobs in this remittance workflow?
• True or False: A single claim run can cover more than one service area.
• What is the primary purpose of ABF and FDF in Epic?
• Which reconciliation levels trigger moving the claim to the error pool?
• Claims reconciliation must be run manually.
• How can claims reconciliation be processed?
• Tables can reference an ID Type from ID maintenance to convert the bank's payer ID to the payer record in Epic.
• Claim edit checks are:
• This indicates that the system will look to the most specific level for a value and continue upward until found. This is known as:
• What happens if there are no rules?
• BWR rules are built using hospital billing rule maintenance. Which option best names this maintenance?
• In hyperspace, which tool lets you identify charge codes that exist in that environment and match a scenario (for example, a diag radiology charge used for testing)?
• How does the payer determine which attachment belongs to which claim?
• After a payer code is updated to an ANSI standard, which of the following steps is appropriate?
• For scan errors caused by a new payer code, _____ the payer code to an ANSI standard code and then reload the remit file.
• If a claim is held in the clearinghouse while it is being worked, what is a potential consequence?
• Which action describes the insurance bucket's use in the reconciliation workflow?
• What does an Account Rule do in relation to an alternate payer?
• The ________ translates the remittance file sent by a payer.
• The _______ translates the remittance file sent by a payer.
• What is the setup called when you must send some charges to another payer for reimbursement?
• Which item is not listed as a method to configure claim forms?
• A rule that identifies a way to divide work, like payer or financial class, will be used as a
• What does the Paper Form Specification primarily define?
• Which statement about ABF and FDF is true regarding Epic claim form customization?
• What is the term used for the payer that Medicare forwards the claim to after initial processing?
• In the HB work queue configuration, rules may appear as warning rules or error rules but are still considered what?
• Where are hospital claim form override options housed?
• Which two specifications are primarily used to customize Epic claim forms?
• ________ _______ allows you to print a paper claim right now and override the claim form, the account class, the TOB and include only selected claim lines
• During remit processing, which statement best describes the role of RMO?
• Resubmitting a claim sends the claim back to the
• Claim Edit Checks are what type of objects in Epic?
• In remittance processing, payments not tied to invoices are handled by posting to which type of account?
• What happens to a fixed claim when it is resubmitted after a fix?
• What defines which records appear in a work queue?
• To set the ACN Attachment Control Number, you must use a copy of which extension?
• When crossover payers are set, Epic will perform which action on the secondary payer's claim?
• ANSI files are also called
• For invoice payments that dont match an invoice or patient in the system, post to a _______ account.
• What best describes the function of the Type of Bill Extension setting in the CDF?
• Accepting the claim changes the liability bucket from:
• To set the ACN, you use a copy of which extension and configure its parameter?
• Which term describes the feature that automatically adds occurrence codes, value codes, and condition codes to a UB claim?
• If a CDF is configured at both plan and payer levels, which level takes precedence?
• In testing a claim edit rule, the key identifier used for testing is the CEV ID.
• Which level is NOT a remittance code mapping level?
• What is the primary purpose of the ACN in attachments?
• What type of rule identifies an error code in the system?
• Where are Claim Edit Work Queue rules found?
• The Medicare A inpatient and Medicare B outpatient example illustrates which concept?
• Which identifier is used for testing claim edit rules when evaluating claim values?
• Claim Edit Checks are categorized as what type of object?
• Claim Edit Work Que rules are tested against which data elements?
• Where is the Coverage Edit Form located in Epic?
• Which pool holds claims that have errors detected during reconciliation?
• Which statement best distinguishes a crossover payer from an alternate payer?
• What is the purpose of delimiters in ANSI files?
• What is the primary purpose of creating and loading a remit run?
• A self-pay RMO allows you to automate posting self pay payments via a flat file from your ______.
• In a crossover payer setup, Epic will do what to the secondary payer's claim?
• If the secondary payer pays first, where will the payment appear until the primary payer responds?
• Claims can only appear in Claim Edit Workques if they are in which pool?
• What does a Charge Rule do in relation to an alternate payer?
• Which term best describes a portal to a specific location in the code enabling a custom function?
• Which acronym is used for payments that are not for invoices?
• Which component translates the remittance file sent by a payer?
• Claims reconciliation creates
• Which subscriber information must the system verify during registration to ensure accurate eligibility and billing?
• When SHOW HCPCS in FL 44 is set to yes, which other setting is required for a HCPCS to print FL44?
• Remittance files should only be processed if the ______ is confirmed.
• When you create a custom claim edit rule, you can also create which companion?
• Batch jobs automate ______ and __________. Processing is automated inside the RMO.
• Claim runs are typically created using the:
• In Epic's data model for reimbursements, payer status information is stored in which bucket?
• What two records does Epic use to designate errors in the error pool from the CDF?
• The claim edit workqueue companion is also known as?
• A loop contains a set of data concerning the same thing.
• What setup automates the creation of additional documentation required by payers with the claim?
• What does the batch scheduler allow?
• Which option lets you send charges on a different claim form than the defaults?
• What happens when a claim is sent to Medicare regarding the secondary payer?
• When you accept a claims reconciliation run, which of the following can happen to claims or accounts?
• Remittance code mapping levels include plan, payer, and service area. Which complete list best describes this capability?
• What is the purpose of a remit option?
• Does Resolute generate another claim for crossover payers?
• RMCs define standard actions for the reason code and can be overridden by scenario using an _______ or a ________ record.
• If the clearinghouse marks a claim as clean, what status will it have when the reconciliation file is loaded?
• When deciding what content appears on the claim attachment, you can use a:
• _____ are payments that are not for invoices.
• Creating a custom claim edit rule also enables the WQ companion, also known as the Claim Edit Assistant.
• How is an attachment control number (ACN) configured?
• Which of the following options lists the three ways to produce a claim from the hospital account?
• The most common context for claim edit rules uses the ____ _____ of the claim for testing.
• System settings for HB are stored in which item?
• Which parameter is adjusted when configuring the ACN in extension 70551?
• Where are claims held before routing to a claim edit workqueues?
• Which of the following describes how a scenario can override RMC actions?
• In Epic, claim edit checks are associated with which component?
• The CDF can be used to _____ a claim in different situations, such as when a recurring account overlaps other accounts.
• The CDF can change many things about how _______ appear on the claim, including maximum quantities and when to combine them onto 1 line.
• The UB screen's automatic claim codes lets you automatically add which codes?
• Which statement best describes CDF responsibilities?
• Use the _____ of the claim to test it against the Work Queue or rules used in the WQ. Which attribute is correct?
• How many service areas can a single claim run include?
• Claim runs are specific to the:
• What is the WQ companion also known as?
• A large amount of configurability exists within the Hospital Billing application. Many of these settings are configured in the:
• Claim edit rules are:
• Claim Edit Work Que rules are tested against which data elements?
• What is the described relationship between Medicare and Medigap?
• For visits that begin in the ER, which date is often used as the admit date?
• How are alternate payers tracked in the system?
• What is the purpose of the ID Type data element in Epic remittance mapping?
• A ______ error indicates the system cannot interpret a remittance code.
• Where should claim splits be configured?
• If a claim edit workqueue has no rules in it, what happens to the claims in the error pool?
• Which data element is used to map the bank's payer ID to the payer record in Epic?
• Which action would move a claim back into the active processing flow after an error has been identified?
• What checks are performed when loading a remit file?
• ANSI files consist of pieces broken up by delimiters; usually there are three pieces broken up by the delimiters.
• What example is given for a charge code lookup in the environment?
• Which tool allows you to add or remove claim definition edits across multiple CDFs and update category cross-reference mapping?
• Which term describes payments that are not for invoices?
• Which type of rule uses a payer or financial class to direct work?
• What is the effect of a crossover payment on claim creation?
• Where can you update payer insurance billing settings?
• Claim values is the most common context for Claim Edit Rules and uses which identifier for testing?
• Which attribute identifies a specific claim for testing within the Work Queue?
• Where can you start a manual claim reconciliation?
• What are the two main claim reconciliation reports?
• Which option allows sending charges on a different claim form than the default?
• Which extension is used to configure the ACN parameter?
• Remittance code mapping can be done at the plan, _____, or service area level.
• Which action is described when a new payer code triggers scan errors and must be mapped to ANSI standards?
• The CDF can override the ____ ____ _____ on the claim in certain situations, like switching it to 132 and 133 for recurring accounts.
• A rule that identifies an error code will be used as the:
• Which numeric field helps route to the appropriate team-owned workqueue?
• When the reconciliation process detects an error at levels 2 and 3, into which pool is the claim moved?
• When the CDF finds an error it sends claims to the
• Which relationship enables the invoice payer to be recorded as the payer on the payment transaction?
• Which type of rule helps break up the workload among multiple workques?
• Which error would indicate the remittance code cannot be read by the system?
• ______ ______ puts the insurance bucket back on the claims queue
• Which statement about a catch-all claim edit work queue is true?
• CDF responsibilities include
• After mapping to ANSI standard codes for a new payer code, what should you do next?
• Where can insurance ID format checks be configured in the system?
• Claim Edit Rules are known as CER Rules.
• Which item is used to match attachments to their corresponding claims in the payer system?
• Electronic claim forms and paper claim forms are in _____ mater files
• What is the recommended number of RMOs per payer per billing system?
• Which rule determines how work is divided, such as by payer or financial class?
• What is one difference between Hospital Billing Rules (rule maintenance) and Rule Editor?
• What term describes having two primary payers for different services?
• When an insurance bucket is waiting for claims processing, it is on:
• Which screen contains the Claims Split Options for configuring claim splits?
• Payer status information is stored on which bucket?
• The print form allows you to:
• Which organization determines claim form and claim medium use?
• The Automatic Claim Codes for UB screen lets you automatically add
• The system can be configured to automatically accept clean claims based on information received in a claim reconciliation file.
• What term describes a claim that has been marked as acceptable for loading?
• If you want to create two separate claims for the same payer with mixed charges, which feature is used?
• When the clearinghouse identifies an error, claims reconciliation levels 2 and 3 will put that claim into:
• In this environment, what best describes an extension?
• What does the Electronic Form Specification primarily define?
• To create two separate claims for the same payer on an account, which feature should you use?
• Demand claims can only be printed for insurance buckets that are:
• Which rules can be used to send charges to the alternate payer?
• Which report lists claim status codes?
• Claims can only appear in Claim edit workqueues if they are in the ____?
• Which field accepts numeric values and determines which claim edit workqueue the claim goes to based on team ownership?
• The admit date for IP Claims can be the Arrival date; what date is often used for visits that begin in ER or OP?
• One of the primary functions of the CDF is to:
• Which three codes are added automatically by the UB screen?
• Which feature is used to create two separate claims for the same payer with some charges on one claim and other charges on the other?
• The _____ ______ determines how high/low or how far left/right the ink prints on the page for a claim.
• What type of override would you use to override multiple related pieces of information onto a claim?
• Which function is performed by CDF with respect to claims errors?