Basics of Healthcare

Module 1:

1. Healthcare claims overview – Institutional, Professional, Dental and Pharmacy
2. Health insurance claims process - Adjudication (Acceptance, Denials, Rejections, and Pends)
3. QNXT Or NASCO - Data model

Module 2:

1. Claims Models;
2. HIPAA Transactions
3. 4010 vs. 5010 Compliance
4. ICD10, HCPCS

Module 3:

1. Medicaid vs. Medicare
2. Business rules
3. Encounters Submission to States and CMS

Module 4:

1. Healthcare Reforms
2. Government Regulations and Guidelines
3. Healthcare links for online resources

Module 5:

1. Discuss Real-time BRD’s and Test Cases