Medicare Advantage: Claims Processing

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. Understand the definition of “clean” and “unclean” claims. Identify the roles of other organizations contracted with CMS to process Original Medicare claims.

After this course learners will be able to identify the appropriate response to a fire at healthcare facilities.