Medicare Advantage: Claims Processing
<p>This course explores the Centers for Medicare and Medicaid Services (CMS) regulations and instructions for the processing of Part C medical claims for Medicare Advantage. Topics in this course include: Rules and Requirements, Benefits and Services, Payment (Claim) Organization Determinations, Claims Processing, and Enrollee Financial Caps. After completing this course, learners will be able to identify the Medicare Advantage plan’s responsibilities in monitoring delegated claims processing.<span> </span></p>
After this course learners will be able to differentiate between contracted and non-contracted providers and how claims should be processed using the reimbursement methodologies as set forth by medicare or contract stipulations, health plan authorization rules and health plan member benefits. identify the turnaround timeframes required for processing claims. recognize the definition of “clean” and “unclean” claims. identify the roles of other organizations contracted with cms to process original medicare claims.