NASCO claims processing System Training tutorial
NAEGS are like enhanced grid summaries for benefit coding of claims.(Like our facets 4.51 application).
*National Accounts Service Company (NASCO)
HEHK-EEC individual claim,
HEUK- EEC work batch unit,
HIQK- Online Inquiry and claims history,
HQAK- Claims entry,
HQGK- free format data corrections,
HQRK- Provider file, etc.
*Online Desk Levels (ODLs) – used during claims processing as a guide as to why claim suspended.
* Online Benefit Narrative (OBN) – used to reference a Groups employee benefits.
* Coordination of Benefits (COB) – used when there is more than one type of coverage for a Subscriber.
* eFlexibile Data Entry (eFDE)- Web-based application used to enter paper claims into the NASCO system, most claims are entered electronically.
* Electronic Error Correction (EEC) – a claims worksheet used to process claims in real-time.
*NASCO Processing System (NPS) – the system in which claims are processed, you may also hear the term “Main Frame” means the same thing.
*Change System Request (CSR) – a document created in Project Data Manager (PDM) – to track or identify a change to current processing.
* Blue Cross Blue Shield Association (BCBSA) – BlueCard policies are mandates by the association.
* Interplan Teleprocessing Service (ITS) – the software to deliver the BlueCard product.
* Automated Development System (ADS) – a letter generating system/hard-coded in the NPS you must request.
* Automated Letter Generating System (ALGS) – a third party letter writing application most plans use/actually produces letters.
*Federal Employees Program (FEP) – is administered by the U.S. Office of Personnel Management (OPM) and holds the largest private health insurance contract in the United States.
* Consumer Directed Health (CDH) – funds are deposited into to Subscribers account by the Group to help off-set medical expenses.
* Central Financial Agency (CFA) a clearinghouse of banking arrangements between the Home and Host Plans. (Blue Cross Blue Shield Plans)
* Explanation of Benefits statement (EOB) – a description of services submitted by a provider identifying services performed on a patient.
* Health Insurance Portability & Accountability Act of 1996 (HIPAA) – a public law which is designed to improve the efficiency of today’s healthcare system by establishing a National Standard for the electronic transmission of healthcare information.
Some important to know in NASCO Tutorials
*American National Standard Institute (ANSI 834 Transaction)
*Health Insurance Portability and Accountability Act (HIPAA Membership Transaction)
*Group Enrollment Maintenance (GEM Application) – MetaVance or Web Client (for Groups)
*Standard Tape Exchange Program (STEP Program) (for Subscribers)
*Membership data can come through Batch Maintenance Interface (BMI) a MetaVance program
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