ICD10 Master Training Activity Plandocshare01.docshare.tips/files/24298/242988657.pdf · Phase Lesson Name Topical Subject Matter Training Audience Training Size Training Deploy Date

Conceptual Learning Impact/Activity

Phase Lesson Name Topical Subject Matter Training Audience Training SizeTraining

Deploy Date

Training

Type

Delivery

Method

(web, class,

Design & Delivery

(Learning Area)

Learning Resource

Name

Analysis

Complete Date

Design/Develop

Complete Date

Overall Percent

Complete

Actuarial 456

Benefit Coding Completed

Claims 7090

Customer Service

Enterprise Data and Reporting 392

Marketing 2226

Medical Management 683

Provider 632

Claims 7155

Enterprise Data and Reporting 392

Medical Management 683

Actuarial & Underwriting 456

1 ICD10 Talking Points Webinar

Provider Facing Employees (Network Reps) within the HCM division will require awareness

of ICD-10, talking points for Provider discussions to ensure provider readiness in 2013, etc.

The Provider Workgroup Leads are planning on conducting webinars in the

September/October 2011 timeframe along with the assistance of OCM Communications

Lead, Clint Geise, for this audience.

Ancillary Contracting

Facility Provider

Professional & Facility

Professional Provider Network

Supervisor Network Operations

HMO Financial Ops – Network

Support

HMO Relations & Ops

Provider Relations

510Sept 2011-Dec

2011Webinar Web (other) HCM Clint Geise 75%

1 ICD10 FAQ

As an extension of the webinars being conducted for the Provider Facing Employees, there

is a need to develop an ICD-10 Frequently Asked Question (FAQ) document with applicable

scripting for the Provider Customer Advocates in SSD. These FAQs should be available in

BlueSource.

Provider Education

Provider Service

Provider Telecommunications

(Provider Customer Advocate)

516 HCM Clint Geise 70%

0

0%

WBT

Form revisions, change of the ICD indicator, Power Entry, Dual Processing, Adjustment

redesigned due to spacing,

primary codes, Claim Lock Criteria/Search Criteria) and ICD-10 Indicator to be added).

Implementing ICD-10: Key Changes1 Abby MillsSSO Learning & DevleopmentWeb

(myLearning)

ICD10 Master Training Activity Plan

ICD-10 Overviewwhat is ICD-10, the variances between ICD-9 and ICD-10, the implementation schedule

including the expectations for dual processing between ICD-9 and ICD-10, etc. 1 WBT

Web

(myLearning)SSO Learning & Devleopment Abby Mills 0%

Phase Work Group Name Name APP ProcessAPP Physical

Design End

App Deploy

EndDelta (Days) Training Impact Training Audience Training Size

Training Size

Range

Training

Deploy Date

Ideal Training

Deploy Date

Training

Type

Delivery

Method

(web, class,

Design & Delivery

(Learning Area)

Learning Resource

Name

Analysis

Complete Date

Design/Develop

Complete Date

BlueSource

Impated?

Overall Percent

Complete

1 Actuarial & Underwriting Actuarial Data Modeling tool w 7/23/2012 2/7/2013 144

1 Actuarial & Underwriting Actuarial Data Strategy/Decision Support Layer w 7/2/2012 5/10/2013 225

1 Actuarial & Underwriting AMU (BA - Underwriting) - Release 1 w w 9/13/2011 3/19/2012 135 none to end users; architecture changes n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

1 Actuarial & Underwriting AMU Pre-Op Environment w w 1/27/2012 10/29/2012 197 none to end users; architecture changes n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

1 Actuarial & Underwriting Application 2 - Clasims Payment System (CPS) w 3/16/2012 10/3/2013 405

1 Actuarial & Underwriting Electronic ClaimsData Retireval Application w 1/27/2012 8/7/2012 138

2 Actuarial & Underwriting HMO Data Mart w 2/23/2012 8/9/2012 121

Data Field expansion and version idicator

added; Implementing ICD10 Lesson will

cover this

2 Actuarial & Underwriting Pricing Processes w



cover this

2 Actuarial & Underwriting Provider Cost and Utiliation w n/a n/a



cover this

2 Actuarial & Underwriting Provider Settlement Database w 1/27/2012 9/13/2012 165



cover this

2 Actuarial & Underwriting Self Service Reporting w 4/2/2012 7/31/2012 87



cover this

2 Benefit Coding/Testing Application 1 (GCPS:1131) w n/a 1/20/2012

2 Claims AutoCoder Replacement w w unknown unknown n/a

new training on Autocoder replacement tool;

No license of McKessons' Autocoder as of

yet

2 Claims Automated Chip Tester w 4/23/2012 10/16/2012 127

2 Claims Automatic Error Resolution w 4/23/2012 10/29/2012 136

2 Claims Blue Chip Claims Status Manager w 4/11/2012 7/22/2012 73

3 Claims Blue Chip Core Adjudication w 11/17/2011 7/22/2012 177

3 Claims Blue Chip Eligibility (BCE) w 11/16/2011 7/22/2012 178

3 Claims Blue Chip Enterprise Front End w 11/17/2011 10/14/2012 237

3 Claims Blue Chip Inquiry w 11/17/2011 10/14/2012 237

3 Claims Blue Exchange 276/277 w 11/10/2011 7/22/2012 182

3 Claims BlueCard LABOR & HPA/ALIM w 7/19/2012 10/14/2012 62

3 Claims BlueChip Application w 11/17/2011 10/14/2012 237

3 Claims BlueChip National Accounts w 11/15/2010 10/14/2012 500

3 Claims BlueGuest w 1/17/2012 10/14/2012 194

3 Claims BlueSquared w 6/15/2012 10/14/2012 86

3 Claims BOS/Superhandler/Notification w 11/17/2011 7/22/2012 177

3 Claims Claim Copy w 4/23/2012 10/30/2012 137

3 Claims Claim Lock w 11/17/2011 10/14/2012 237

Involved in the Awareness module #2

showing changes;The ICD related fields on

the Claim Lock user interface screens will

need to be expanded.

Claim Lock Screen

Claim Lock Search Screen

ICD Version Code indicator will need to be

added as one of the lock criteria on the Claim

Lock Screen.

Claims Processors; Claims

Examiners, Claimes Technicians

3 Claims Claims Recovery w 10/5/2011 n/a none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

3 Claims Claims Status Inquiry w w 4/18/2012 7/22/2012 68 BlueSource only; training not needed

3 Claims CMMouse - International Mouse w 4/23/2012 10/30/2012 137

4 Claims CMMouse - Quality w 4/23/2012 10/30/2012 137

4 Claims CMMouse Processor w 4/23/2012 10/30/2012 137

4 Claims CMS/Claim Forms w w n/a n/a none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

4 Claims COB - CMMouse w 4/23/2012 10/30/2012 137

4 Claims COB (BlueChip) w 11/17/2011 10/14/2012 237 none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

4 Claims Create & Route/Advanced Logic Enhancement w 4/23/2012 10/30/2012 137

4 Claims DME Tracker w 4/23/2012 10/30/2012 137

4 Claims Duplicate Advanced Logic Enhancement w 4/23/2012 10/30/2012 137

The impact is to Professional claims, not

Facility. The first four digits of the diagnosis

code will be looked at during the dup check

process. Some information is documented in

the logical & physical design documents.

Claims Processors; Claims

Examiners

4 Claims ECLAIMS (Electronic Claim Edit and Response System) w n/a n/a

4 Claims EOB w 11/17/2011 7/22/2012 177

Table 12 fields in the EOB online message

table and EOB screens (EG12, EG19 and

EG44) will have to be updated as per the ICD

10 mandate. 4 Claims F4 Quickview w 4/23/2012 10/30/2012 137

4 Claims FEP Claims Adjudication w 9/14/2012 10/8/2012 17

4 Claims GCQE w 4/23/2012 10/30/2012 137

4 Claims Get PRAP Info w 4/23/2012 10/30/2012 137

4 Claims HMO Away from Home Care w 1/17/2012 10/14/2012 194

4 Claims ITS (Interplan Teleprocessing System) w 11/15/2010 10/14/2012 500

4 Claims J Code Calculator w 4/23/2012 10/30/2012 137

4 Claims LEGS/LIPS w n/a n/a none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

4 Claims Liquid w 4/23/2012 10/30/2012 137

4 Claims M@GIK w 4/23/2012 10/29/2012 136

4 Claims Medicare Recon Engine w 4/23/2012 10/29/2012 136

4 Claims Paper Claims in FSUs w

4 Claims Paperless Inventory w 6/14/2012 10/14/2012 87

4 Claims Remote Desktop Processor w 4/3/2012 10/23/2012 146

4 Claims RTIS (Real Time Input System) w 11/17/2011 10/14/2012 237

4 Claims State Farm Banking w 4/23/2012 10/30/2012 137

4 Claims Subrogation Files w n/a n/a BlueSource only

4 Claims Super ID Menu w 4/23/2012 10/30/2012 137

4 Claims IMNU Screens w n/a n/a

Awareness of changes; The ICD fields on the

Inquiry screen will need to be expanded.

ICD1, ICD2, ICD3

ISVD, ISVX

IPCD

ZCD1, ZCPD

GDSX, GDSV

Claim Level Screens:

ICD1, ICD2, ICD3

IPCD, ZCD1, ZPCD

ICL1, ICL7, IPL1, IPL7

Service Level Screens:

ISVD

GDSV


mailto:M@GIK

Phase Work Group Name Name APP ProcessAPP Physical

Design End

App Deploy

EndDelta (Days) Training Impact Training Audience Training Size

Training Size

Range

Training

Deploy Date

Ideal Training

Deploy Date

Training

Type

Delivery

Method

(web, class,

Design & Delivery

(Learning Area)

Learning Resource

Name

Analysis

Complete Date

Design/Develop

Complete Date

BlueSource

Impated?

Overall Percent

Complete


4 Claims Claim Adjustments w n/a n/a

The ICD Version Indicator will need to be

copied onto the new claim that is created to

complete an adjustment.

4 Customer Service (PTC Claims)/Claims Payment Review (CPR) w 4/12/2012 10/14/2012 132

4 Customer Service BAE Portal w 6/24/2011 7/22/2012 281

4 Customer Service BAM Portal w 6/24/2011 7/22/2012 281

4 Customer Service Enterprise IVR (eIVR) w n/a 10/14/2012

4 Customer Service Incentive Processor w 7/12/2011 10/14/2012 329

4 Customer Service RTB w 6/20/2012 10/14/2012 83

4 Customer Service Siebel CSR Dashboard w 6/30/2011 7/22/2012 277

4 Enterprise Reporting Enterprise Data Warehouse w 8/17/2011 11/10/2011 62

4 Enterprise Reporting Workstream 1 - Fraud & Abuse (FAMS) w 10/21/2011 5/14/2012 147

4 Enterprise Reporting Workstream 1 - Fraud & Abuse (Report Gen) w 10/21/2011 4/19/2012 130

4 Enterprise Reporting Workstream 3 - Enterprise Reporting (Sergio - 1127) w 12/19/2011 5/3/2012 99

4 Finance & Reporting Application 1 - Blue Gateway w 3/16/2012 10/2/2012 143

4 Finance & Reporting Application 6 - Provider Contracting System w 10/31/2011 10/31/2012 263

4 Finance & Reporting Application 7 - BARS (Billing & Accounts Recieveable) w 3/16/2012 10/2/2012 143

4 Inquiry IMNU Screens w n/a n/a

Awareness of changes; The ICD fields on the

Inquiry screen will need to be expanded.

ICD1, ICD2, ICD3

ISVD, ISVX

IPCD

ZCD1, ZCPD

GDSX, GDSV

Claim Level Screens:

ICD1, ICD2, ICD3

IPCD, ZCD1, ZPCD

ICL1, ICL7, IPL1, IPL7

Service Level Screens:

ISVD

GDSV

4 Medical Management IMM Web w 7/9/2012 9/28/2012 60

4 Medical Management Medical Policy w 8/29/2011 12/9/2011 75

4 Medical Management Precert KI w 7/9/2012 9/28/2012 60

5 Provider ACES from Actuarial Workgroup w 12/8/2011 10/3/2011 (49) none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

5 Provider APG Pricing w 4/2/2012 10/1/2012 131 none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

5 Provider APG Provider Application Website Reporting w 2/14/2012 3/14/2012 22 none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

5 Provider BlueAccess Application - Provider Portal w 2/28/2012 3/27/2012 21 none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

5 Provider Burgess AuotPricer w 5/1/2012 10/1/2012 110 none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

5 Provider Claims Xten w 4/23/2012 10/1/2012 116 none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

Provider ClearClaimConnection w 5/1/2012 10/1/2012 110 none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

Provider D2 Hawkeye w 8/6/2012 6/22/2012 (32) none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

4 Provider DRG Grouper w 5/1/2012 10/1/2012 110 none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

4 Provider PIPS w 7/31/2012 5/17/2012 (54) none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

4 Provider PRCDR2 (Proc Master App - Validation Services) w 12/8/2011 10/1/2012 213 none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

Provider PREMIER Pricing w 9/2/2011 10/3/2011 22

Pricing personnel will need to understand

the changes to Premier Pricing due to the

addition and maintenance of ICD-9 and ICD-

10 codes sets to support claims processing

with ICD-9 codes prior to 10/1/13 and ICD-

10 codes on 10/1/13 and after

Provider PREMIER Risk w 9/2/2011 10/3/2011 22 none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

Provider Provider Reimbursement System w 1/31/2012 4/13/2012 54 none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

Provider Research & Analytics - Encounters Database w 7/5/2012 3/20/2012 (78) none to end users n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a N n/a

SSDTech Recycle Tool box w n/a n/a

BlueSource/awareness: Recycle Tool box

Screens and copybooks will be updated to

accommodate the increased length of ICD

codes.

SSDTech April 2012 Contract Release w

• Overview of variances from ICD-9 to ICD-

10 Coding (ANSI & ICD-10: On the Horizon

will serve this purpose and concepts will be

reinforced in subsequent training).

• Premier Code Group (PCG) Training: GCPS

specific training due to the usage of Premier

Code Groups instead of individual ICD code

(tentative release date of April 2012).

• Accessing prototypes to set up and

support new account group benefit coding

using Premier Code Groups as well as ICD

codes.

• New functionality which provides the

ability to specify diagnosis and procedure

codes in tabulars by including or excluding

by the Premier condition code groups (for

example, all in fertility, all in TMJ, all out in

fertility, all out maternity, etc.). Tabulars

impacted include:

• Contract Tabular: CLDR

• Contract Tabular: CRR

• Group Specific Tabular GMSR

• Benefit Provision Tabular PDR

• Benefit Provision Tabular PRR

• New logic and error message to identify

when an ICD code doesn't exist or is

inactive/terminated, by checking and

displaying effective and end dates on the

following tabulars:

• Contract Tabular: CLDR

• Contract Tabular: CRR

Benefit Coders; SSDTech

Quality Analysts, QAI Quality

Analysts, Benefit Testers,

Marketing Representatives

4 Inquiry EOB w 11/17/2011 7/22/2012 177

Awareness: Table 12 fields in the EOB online

message table and EOB screens (EG12, EG19

and EG44) will have to be updated as per the

ICD 10 mandate. Inquiry RTB w

Work Group

ICD

-10

Ove

rvie

w

Imp

lem

enti

ng

ICD

-10:

Ke

y

Bu

sin

ess

De

cisi

on

s

Un

der

stan

din

g th

e

Tra

nsl

atio

n o

f IC

D-9

to

ICD

-

10

Co

de

s

Telli

ng

the

Sto

ry: I

CD

-9 t

o

ICD

-10

(V

aria

nce

s)

Au

toco

de

Re

pla

cem

en

t

Pre

mie

r C

od

e G

rou

p (

PC

G)

Tra

inin

g

PC

G A

war

en

ess

& U

pd

ate

Test

Cas

es

PC

G A

war

en

ess

wit

h C

od

e

List

ing

Rea

l Tim

e B

en

efit

s (R

TB)

Ch

ange

s D

ue

to P

CG

RTB

- P

CG

S an

d B

ITS

Das

hb

oar

d R

evi

sio

ns

Imp

lem

enti

ng

ICD

-10:

Ke

y

Bu

sin

ess

De

cisi

on

s fo

r

Me

d. M

an

age

me

nt

Enco

der

Pro

tra

inin

g

Cla

im E

xte

nd

Tra

inin

g

IMM

We

b T

rain

ing

ICD

-10

Tal

kin

g P

oin

ts

We

bin

ar

ICD

-10

FA

Q (

Bas

ed

on

Web

ina

r co

nte

nt)

Actuarial 456

Benefit Coding Fulfilled 212 177 100 35 212

Claims 7090 7155 7081 5022 5022

Customer Service

Enterprise Data and Reporting 392 392 24 38 171 171

Marketing 2226 413

Medical Management 683 683 683 495 53 55 113

Provider 632 209 516

Total 11479 8230 24 451 7976 348 100 35 383 5022 5022 495 53 55 113 209 516

Actuarial Actuary 216 May need communication support to announce the availability of the Overview lesson.

Actuarial Consumer Market Telephone Area 84

Finance/ Large Group Underwriter 41

Underwriting Middle Markets Underwriter 33

National/Major Accounts Underwriter 31

Small Group Underwriter 41

L&D & Quality Underwriter 10

TOTAL 456 Source: HR Audience Listing as of March 2011Jo

b C

ate

gory

ICD

-10

Ove

rvie

w

Co

mm

en

ts

Div

isio

n/

De

par

tme

nt

SSD - IL Benefit

Coding

SSD - OK Benefit

Coding

Benefit Coding Analyst II 15 15 15 15

SSD - TX Benefit

CodingBenefit Coding Analyst III 24 24 24 24

Lead Benefit Coding Analyst 6 6 6 6

SSD - CCSP Benefit Coding Management 6 6 6 6

DTU Testers (45)

FSU Testers (55)

SSD – QAI Quality Auditors/QAI Management 35 35 35 35 More if Claims/Inquiry Impacts Identified

TOTAL 212 177 100 35 212 212

Notes:

1 Benefit Coding Analyst III and 1 Lead Benefit Analyst are in the CCSP Department

* Benefit Coding & Testing staff have already completed the learning vignette

These audience groups will require advance training to ensure contracts are established prior to October 2013 compliance date.

Sources:

1) HR Audience Listing as of March 14, 2011

Div

isio

n/

Dep

artm

ent

100

Au

toco

der

Rep

lace

men

t

Rea

l Tim

e B

enef

its

(RTB

) D

ue

to P

CG

Co

mm

ents

Benefit Coding Analyst I 26 26 26 26

Job

Cat

ego

ry

AN

SI &

ICD

-10

On

Th

e

Ho

rizo

n V

ign

ette

SSD -DTU/FSU 100 100 100 100

Pre

mie

r C

od

e G

rou

p

(PC

G)

Tra

inin

g

Pre

mie

r C

od

e G

rou

p

Aw

aren

ess

& U

pd

ate

Test

Cas

es

Pre

mie

r C

od

e G

rou

p

Aw

aren

ess

wit

h C

od

e

List

ing

SSD/ Power Entry Operators 32 32 0

SSO Claims Processors 635 635 635

Claims Examiners 1111 1111 1111

Technicians 385 385 385

Coordinators 113 113 113 Cannot distinguish between Claim and Inquiry Coordinator.

Developmental Specialists 64 64 64 Cannot distinguish between Claim and Inquiry DS.

FSU Test Coordinator 45 45 45

Supervisors/Sr. Supervisor 466 466 466

Management (UM & Above) 84 84 84

Claims Screeners 43 42 0

Customer Advocates (Specialist, Technician, CA Examiner) 2637 2637 2637

Group Benefit Specialist 95 95 95

Reimbursement Customer Advocate 18 18 18

Reimbursement Negotiator 156 156 156

Business Specialists/Analyst 231 231 231

Benefit Coders * 65 65 * Benefit Coders have already completed Vignette

Interplan Business Specialists 32 32 32 Any Blue Card Specific Needs?

Quality Analysts/Auditors (includes CA Auditor) 96 96 96

Medical Review Staff 31 31 31 Other Needs?

Provider Education Specialists 32 32 32

Provider Specialists (PASS) 20 20 20

Provider Customer Advocates 539 539 539

Instructional Designers & Technical Writers (SSO L&D) 39 39 39

Performance Specialists (SSD & SSO L&D) 25 25 25

Quality Analysts (SSD & SSO QAI) 161 161 161

TOTAL 7090 7155 7081

Sources:

1) HR Audience Listing as of March 2011

Co

mm

en

ts

Div

isio

n/

De

par

tme

nt

Job

Cat

ego

ry

ICD

-10

Ove

rvie

w

Imp

lem

en

tin

g

ICD

-10

: K

ey

Bu

sin

ess

De

cisi

on

s

Au

toco

de

r

Re

pla

cem

en

t

Trai

nin

g

Customer Advocate (I, II, & III, Specialist, Technician, CA Examiner) 2637 2637

Reimbursement Customer Advocate 18 18

Provider Customer Advocate 539 539

Customer Advocate Auditor 89 89

Technicians 385 385 Cannot distinguish between Claim and Inquiry Technician.

Coordinators 113 113 Cannot distinguish between Claim and Inquiry Coordinator.

Group Benefit Specialist 95 95 Cannot distinguish between Claim and Inquiry Group Benefit Specialist.

Medical Review Staff 31 31

Instructional Designers & Technical Writers (SSO L&D) 39 39

Performance Specialists (SSD & SSO L&D) 25 25

Quality Analysts (SSD & SSO QAI) 161 161

Business Specialists/Analysts 231 231

Developmental Specialist 64 64 Cannot distinguish between Claim and Inquiry DS.

FSU Test Coordinator 45 45

Supervisors/Sr. Supervisor 466 466 Cannot distinguish between Claim and Inquiry Sups.

Management (UM & Above) 84 84 Cannot distinguish between Claim & Inquiry Management.

TOTAL 5022 5022 Source: HR Audience Listing as of March 2011

Job

Cat

ego

ry

RTB

– P

CG

s

& B

ITS

Das

hb

oar

d

Re

visi

on

s

Co

mm

en

ts

SSD/SSO

Div

isio

n/

De

par

tme

nt

Un

der

stan

din

g

the

Tran

slat

ion

of

ICD

-9 t

o

ICD

-10

Co

de

s

Special Investigations (NM, OK & TX) 24 24 24 0 24 24

Internal & Customer Audit 106 106 0 0 106 106

Performance Guarantee (IL, NM, OK, & TX) 41 41 0 0 41 41

All Employees, Except Client Consultants 161 161 0 0 0 0

Client Consultants 38 38 0 38 0 0

SSO Planning & Reporting 22 22 0 0 0 0

TOTAL 392 392 24 38 171 171 Source: HR Audience Listing as of March 2011

Co

mm

ents

CASSIPThis audience will also need the training identified by the Claims and Customer Service

Workgroup since they utilize Blue Chip, RTB, and Premier.

AIM

Div

isio

n/

Dep

artm

ent

Job

Cat

ego

ry

ICD

-10

Ove

rvie

w

Imp

lem

enti

ng

ICD

-10:

Ke

y B

usi

nes

s D

ecis

ion

s

Telli

ng

the

Sto

ry:

ICD

-9

to IC

D-1

0 (V

aria

nce

s)

Pre

mie

r -

PC

Gs

RTB

Ch

ange

s D

ue

to

PC

Gs

Marketing Marketing Representative 413 413

TX & SW

ServiceAll Employees 1813 TBD Need to confirm which Marketing Reps will need Telling the Story.

TOTAL 2226 Sources; HR Audience Listing as of March 2011Jo

b C

ate

gory

ICD

-1

0 O

verv

iew

Telli

ng

the

Sto

ry:

ICD

-9 t

o IC

D-1

0

(Var

ian

ces)

Co

mm

en

ts

Div

isio

n/

De

par

tme

nt

Div

isio

n/

De

par

tme

nt

Na

me

HCM Medical Directors 17 17

HCM Customer Advocates 60 60 60 60

HCM Case Managers 163 163 163 163

HCM Care Coordinators 86 86 86 86

HCM Health Coordinators 117 117 117

HCM CM Health Advocates 168 168 168 168

HCM Data Analysts 7 7

HCM Metabolic Syndrome Trainers 4 4 4

HCM Review Units (RNs in 4 States) 43 43 43 43 43 43 43

HCM Post

Service

Review

Units

Enterprise PSR: Investigate Analysts, Quality Auditor Support Staff10 10 10 10 10 10 10

HCM

Medical

Policy

Medical Policy Reviewers/Analysts 2 2 2 2 2

Behavioral

HealthCoordinators 134 134 134 134

Behavioral

HealthReview 6 6 6 6

EHCM L&D EHCM L&D Staff 6 6 6 6

TOTAL 683 683 495 683 53 55 113

Sources:

1) HR Audience Listing as of Sept. 2011

Cla

im E

xte

nd

Trai

nin

g

IMM

We

b

Trai

nin

g

Job

Cat

ego

ry

ICD

-10

Ove

rvie

w

Imp

lem

en

tin

g

ICD

-10

: K

ey

Bu

sin

ess

De

cisi

on

s fo

r U

nd

ers

tan

din

g th

e

Tran

slat

ion

of

ICD

-9 t

o IC

D-

Au

toco

de

r

Re

pla

cem

en

t

Trai

nin

g

Enco

de

r P

ro

trai

nin

g

Ancillary Contracting 2 2

Facility Provider 39 39

Professional & Facility 12 12

Professional Provider Network 108 108

Supervisor Network Operations 12 12

HMO Financial Ops – Network Support 4 4

HMO Relations & Ops 22 22

Provider Relations 10 10

Provider Education 4 4

Provider Service 56 56

Provider Telecommunications (Provider Customer Advocate)* 456

E-Commerce 16

HMO Financial Ops 0 Pricing & DB 3

Indian Health Services 81

Network Ops – Credentialing Provider File 111

Network Performance 20

Network Reporting 3

Pharmacy 29

Physicians Relations/Affairs Network Reporting 3

Provider Network Strategies 8

Provider Analytics 35

Provider Communications 5

Provider/Network Reimbursement 43

Vendor & IPA Advocate 1

Specialty Program Manager 1

Medical Program Specialist 1

Outcomes Reporting Analyst 1

Unit Manager, NRS 1

Business Analyst III/ICD-10 SME 1

TOTAL 632 209 516 TBD

Div

isio

n/

De

par

tme

nt

Other

Provider

Audiences

HCM –

Provider

Contracting

Requested assistance from Dennis to determine which audiences require Premier training.

Provider

Relations

(HCM)

Provider

Services

(SSD)

* Other training needs have been identified for this group by the Claims & Customer Service Workgroup

Job

Cat

ego

ry

ICD

-10

Ove

rvie

w

ICD

-10

Tal

kin

g

Po

ints

/We

bin

ar

ICD

-10

FA

Q

(Bas

ed

on

We

bin

ar

Co

nte

nt)

Pre

mie

r Sy

ste

m

Ch

ange

s

Co

mm

en

ts

ICD-10 Impact Analysis to Exisiting Learning/Curricula

Claims Examiner Provider Inquiry CA ITG SSD Tech EISM

H = High Impact - total overhaul of lesson73 10 2 2 0 0 0

M = Medium Impact - partial lesson

change56 13 11 9 0 0 2

L = Low Impact - awareness only 43 0 8 0 0 0 1

NA - Not Applicable 40 0 0 0 0 0 0

270-271 Inquiry Eligibility 0 0 0 0 0 0 0276-277 Claims Status Inquiry 0 0 22 0 0 0 0278 Precertification 0 0 0 0 0 0 0834 Enrollment/ 820 Premium Bill 0 0 0 0 0 0 0835 Remittance 0 0 0 0 0 0 0837 Claims/ NCPDP D.O. 0 0 6 0 0 0 0

ACT = Activity 75 0 7 85 0 0 1EX = Exercise 0 0 0 0 0 0 0SIM = Simulation 40 0 3 35 0 0 0PF = Process Flow 0 0 0 0 0 0 0HO = Handout 0 0 0 0 0 0 0

C = Conceptual 118 13 14 64 0 0 0

J = Job Aid 0 0 0 0 0 0 0

ILT = Instructor Led Training 20 0 2 51 0 0 1

FG = Facilitator Guide 0 0 3 0 0 0 1

PG = Participant Guide 0 0 1 0 0 0 0

Blue Source14 0 9 0 0 0 0

Course Impact Level

Forms Impacted (ANSI 5010 Scope)

Impacted Type

Impact Summary

ICD-10 Impact Analysis - Claims Curriculum

Course Code Course Name Impacted Lesson Name Impacted Type BlueSource

Impacted

Forms Impacted Impact Level

SSD1170 Logging On

Logging on to the Corporate Systems OverviewC N N/A

Signing On and Off using CMMouse ILT N N/A

Activity: Logging On ACT N N/ASSD1168 BlueSource

BlueSource Overview C N N/A

BlueSource Activity C N N/ASSD1168CCSP BlueSource

BlueSource Overview C N N/A

BlueSource Activity C N N/ASSD1171 Claim Types

Claim Form Overview C N L

Claim Forms ACT Y L

Claim Attachments Overview C N LSSD1198 Image

Image Overview C/SIM N M

Image: Get Work, Route, and Windup CSIM N M

SSD1173 Claim Processing

Blue Chip Overview C N M

Processing a Claim Overview C N MSSD1173CCSP Claim Processing

Blue Chip Overview C N M

Processing a Claim Overview C N MSSD1175 Finding Error Message Resolutions in BlueSource

Finding Error Message Resolutions in BlueSource C Y MSSD1175CCSP Finding Error Message Resolutions in BlueSource

Finding Error Message Resolutions in BlueSource C Y MSSD1460 Member Inquiry Search (EEP ONLY)

Member Inquiry Search C N N/A

Member Inquiry Search Activity ACT N N/ASSD1197 BlueSTAR

BlueSTAR Overview C?SIM N M

BlueSTAR: Patient First Name Not Same C/SIM N M

Working with BlueSTAR ACT N N/ASSD1134 National Provider Identifier (NPI)

National Provider Identifier (NPI) Overview C N HSSD1134CCSP National Provider Identifier (NPI)

National Provider Identifier (NPI) Overview C N HSSD1500 Provider Inquiry Search (EEP ONLY)

Provider Inquiry Overview C N N/A

Provider Inquiry Activity ACT N N/ASSD1300 PFIN Overview

PFIN Overview C N N/A

247507926.xlsx.ms_office - Claims

K. Pollard 14 of 69 10/14/2014



Impacted


SSD1300CCSP PFIN Overview

PFIN Overview C N N/ASSD1131 PFIN Illinois and New Mexico

PFIN Illinois and New Mexico C N N/A

Working with PFIN Illinois and New Mexico ACT N N/ASSD1131CCSP PFIN Illinois and New Mexico

PFIN Illinois and New Mexico C N N/A

Working with PFIN Illinois and New Mexico ACT N N/ASSD1132 PFIN Texas

PFIN Texas Overview C N N/A

PFIN Texas PPN C N M

Working with PFIN Texas ACT N N/ASSD1132CCSP PFIN Texas

PFIN Texas Overview C N N/A

PFIN Texas PPN C N M

Working with PFIN Texas ACT N N/ASSD1132 PFIN Oklahoma

PFIN Oklahoma Overview C N N/A

PFIN Oklahoma PPN C N M

Working with PFIN Oklahoma ACT N N/ASSD1132CCSP PFIN Oklahoma - NEW LESSON - This lesson needs created

PFIN Oklahoma Overview - NEW C N N/A

PFIN Oklahoma PPN - NEW C N M

Working with PFIN Oklahoma - NEW ACT N N/ASSD2004 Member Touchpoint Measures (Not sure who owns this?)

Member Touchpoint Measures (MTM) Overview C N N/A

Member Touchpoint Measures (MTM) Claims Overview C N N/ASSD1176 Processing Professional Claims

Professional Claim Set-Up Activities ILT N L

Processing a Professional Claim I

ILT N L

Processing a Professional Claim II

ACT N H

Professional Claim Quality Check C/SIM N L

Processing Professional Claims

ACT N HSSD1177 Processing Institutional Claims

Institutional Claim Set-Up Activities ILT N L

Processing an Institutional Claim I

ILT N L


K. Pollard 15 of 69 10/14/2014



Impacted


Processing an Institutional Claim II

ILT N H

Institutional Claim Quality Check C/SIM N L

Processing Institutional Claims

ACT N H

Activity: Processing Professional and Institutional

ClaimsACT N H

Selecting the Correct Provider Number in PFINILT N L

SSD2403WBT01 Verifying Workmans Compensation

Verifying Workmans Compensation C N LSSD1179 Processing Claim Errors

Eligibility Errors Overview C/SIM H

Claim Level Data Errors Overview C/SIM H

Service Line Errors Overview C MSSD1179CCSP Processing Claim Errors

Eligibility Errors Overview C M

Claim Level Data Errors Overview C/SIM H

Service Line Errors Overview C MSSD1301 Completing the COB Other Carrier Add Screens

Completing the COB Other Carrier Add Screens C/SIM Y MSSD1301CCSP Completing the COB Other Carrier Add Screens

Completing the COB Other Carrier Add Screens C/SIM Y MActivity: Processing Claims

Processing ClaimsACT Y H

SSD1169 PREMIER

PREMIER Overview C Y H

PREMIER Activity C Y HSSD1181 Autocoder (GMCD)

Autocoder (GMCD) Overview C Y H

Autocoder (GMCD) Activity C Y H

Translating Procedure and Diagnosis Codes Claims Processing

ACT HSSD1182 Inquiry Begin Menu (IMNU)

IMNU Overview C N L

IMNU Path 1 Overview C/SIM N H

IMNU Path 11 Overview C N L

Getting Started with IMNU ILT N L

IMNU Scavenger Hunt ACT N H

IMNU Worksheet ACT N H


K. Pollard 16 of 69 10/14/2014



Impacted


SSD1183 Duplicate Claims

Duplicate Claim Overview C Y L

Duplicate Advanced Logic Enhancement

Overview C/SIM Y L

Group Activity: Processing Duplicate ClaimsACT N M

Processing Duplicate Claims

ACT N HSSD1310 Medicare Overview

Medicare Overview C N L

Medicare Claim Attachments Overview (EOMB,

PCS, ERA) C N L

Activity: Interpreting Explanation of Medicare

Benefits (EOMB)ACT N L

SSD1311 Using Support Files to Process Medicare Claims

BlueSTAR: Determining Medicare Primary Secondary C N NASSD1311CCSP01 Using Member Inquiry Search to Determine Medicare Primary Secondary

Using Member Inquiry Search to Determine Medicare Primary SecondaryC N N/ASSD1312 Processing Professional Medicare Claims

Completing the Eligibility (GELG) Screen for

Professional Medicare Claims C N N/A

Determining Medicare Paid and Patient LiabilityC N L

Medicare Professional Approved Amounts &

Investigation Codes (2, 7, 9, P) Overview C N

Processing a Medicare Professional Claim with

Approved Amounts C/SIM N M

Activity: Determining Medicare Investigation

Codes with Approved Amounts ACT N H

Processing a Professional Medicare Claim with

Approved Amounts ILT N

Activity: Processing Professional Medicare Claims

with Approved Amounts ACT N H

Medicare Professional Zero Approved Amounts

& Investigation Codes (5, F, H) Overview C/SIM N M

Acitivty: Determining Medicare Investigation

Codes with Zero Approved AmountsACT N


K. Pollard 17 of 69 10/14/2014



Impacted


Activity: Processing Professional Claims with Zero

Approved Amounts (5 claims)ACT N H

Processing a Professional Medicare Claim

without an EOMB C N L

Activity: Processing Professional Claims without

an EOMB (5 Claims)ACT N H

SSD1312CCSP Processing Professional Medicare Claims

Completing the Eligibility (GEEP) Screen for

Professional Medicare Claims C N

Determining Medicare Paid and Patient LiabilityC N L

Medicare Professional Approved Amounts &

Investigation Codes (2, 7, 9, P) Overview C N

Processing a Medicare Professional Claim with

Approved Amounts C/SIM N M

Activity: Determining Medicare Investigation

Codes with Approved Amounts ACT N H

Processing a Professional Medicare Claim with

Approved Amounts ILT N

Activity: Processing Professional Medicare Claims

with Approved Amounts ACT N H

Medicare Professional Zero Approved Amounts

& Investigation Codes (5, F, H) Overview C/SIM N M

Acitivty: Determining Medicare Investigation

Codes with Zero Approved AmountsACT N

Activity: Processing Professional Claims with Zero

Approved Amounts ACT N H

Processing a Professional Medicare Claim

without an EOMB C N L

Activity: Processing Professional Claims without

an EOMB (5 Claims)ACT N H

SSD1313 Processing Institional Medicare Claims

Medicare Institutional Claim, Attachment

(Medicare Voucher) and Value & Investigation

Codes Overview C N L

Determining Medicare Paid and Patient Liability

(Inpatient & Outpatient) C N L


K. Pollard 18 of 69 10/14/2014



Impacted


Processing an Institutional Medicare Claim C/SIM N H

Processing Outpatient Institutional Claim w/o

Value Codes & Voucher Attached C N

Determining Medicare Paid and Patient Liability

Amounts ACT N

Processing a Medicare Institutional Claim ILT N

Processing Medicare Institutional Claims with

Value Codes or Medicare AttachmentsACT N H

Processing Medicare Claims Blended Activity

ACT N H

Processing Medicare Claims - Timed Application

ACT N HSSD1184 Subscriber Submitted Claims

Subscriber Submitted Claims Overview C N M

Processing Subscriber Submitted Claims

ACT N HSSD1184CCSP Subscriber Submitted Claims

Subscriber Submitted Claims Overview C N M

Processing Subscriber Submitted Claims

ACT N HSSD1314 Processing Explanation of Medicare Benefits (EOMB) Claims

Processing an EOMB Professional Claim without a Claim FormC N LClaim Processing Activity I - Processing Non-Medicare and Medicare Claims

Processing Non-Medicare and Medicare Claims

ACT N H

Application Exercise - Non-Medicare and Medicare Claims

ACT N HSSD1186 Provider Add Claims

Provider Add Claim Overview C?SIM N M

Processing Provider Add Claims

ACT N H

Processing Medicare Provider Add Claims

ACT N HSSD1186CCSP Provider Add Claims

Performing a Provider Add Overview C N M


K. Pollard 19 of 69 10/14/2014



Impacted


Processing Provider Add Claims

ACT N H

Processing Medicare Provider Add Claims

ACT N HSSD1187 Prescription Drug Claims

Prescription Drug Claims Overview C N L

Processing a Prescription Drug Claim C/SIM N M

Processing Prescription Drug Claims

ACT N H

Processing Medicare Prescription Drug Claims

ACT N HSSD1187CCSP Prescription Drug Claims

Prescription Drug Claims Overview C N L

Processing Prescription Drug Claims

ACT N H

Processing Medicare Prescription Drug Claims

ACT N HSSD1373 State of Texas (SOT) Processing Prescription Drug Claims (SOT Traininees Only)

SOT Prescription Drug Claim Overview C N LSSD1373CCSP State of Texas (SOT) Processing Prescription Drug Claims (SOT Traininees Only)

SOT Prescription Drug Claim Overview C N LSSD1188 Incremented Claims

Incremented Claims Overview C/SIM N H

Processing Incremented Claims

ACT N HSSD1188CCSP Incremented Claims

Incremented Claims Overview C N H

Processing Incremented IClaims

ACT N HSSD1319 Incrementing Medicare Claims

Incrementing Medicare Claims C N

Processing Incremented Medicare Claims

ACT N HSSD1189 Accident and Onset Date Claims

Accident and Onset Date Claims Overview C N M


K. Pollard 20 of 69 10/14/2014



Impacted


Processing Accident/Onset Date Claims

ACT N H

Processing Medicare Accident/Onset Date Claims

ACT N HSSD1190 Ambulance Claims

Ambulance Claims Overview C/SIM N M

Processing Ambulance Claims

ACT N H

Processing Medicare Ambulance Claims

ACT N HSSD1191 Surgery Claims

Surgery Claims Overview C/SIM N M

Processing Surgery Claims

ACT N H

Processing Medicare Surgery Claims

ACT N HSSD1192 Anesthesia Claims

Anesthesia Claims Overview C N M

Processing Anesthesia Claims

ACT N H

Processing Medicare Anesthesia Claims

ACT N HSSD1193 Durable Medical Equipment (DME) Claims

Durable Medical Equipment (DME) Claims Overview C/SIM N M

Processing Durable Medical Equipment (DME) Claims

ACT N H

Processing Medicare DME Claims

ACT N HSSD1194 State Medical Assistance Program (SMAP) Claims

State Medical Assistance Program (SMAP) Claims OverviewC N M

Processing a State Medical Assistance Program (SMAP) ClaimsILT N M

Processing SMAP Claims

ACT N H


K. Pollard 21 of 69 10/14/2014



Impacted


SSD1194CCSP State Medical Assistance Program (SMAP) Claims

State Medical Assistance Program (SMAP) Claims OverviewC N M

Processing a State Medical Assistance Program (SMAP) ClaimsILT N M

Processing SMAP Claims

ACT N HSSD1195 SNF and CHC Claims

SNF and CHC Claim Overview C N M

Processing SNF and CHC Claims

ACT N H

Processing Medicare SNF and CHC Claims ILT N M

Processing Medicare SNF and CHC Claims

ACT N HSSD1195CCSP SNF and CHC Claims

SNF and CHC Claim Overview C N M

Processing SNF and CHC Claims

ACT N H

Processing Medicare SNF and CHC Claims ILT N M

Processing Medicare SNF and CHC Claims

ACT N HClaim Processing Activity II - Processing Non-Medicare and Medicare Claims

Processing Non-Medicare and Medicare Claims

ACT N H

Application Exercise - Non-Medicare and Medicare Claims

ACT N HSSD1316 Processing Medicare Veterans Administration (VA) and Military Treatment Facility (MTF) Claims

Medicare VA and MTF Claims Overview C N L

Processing a Medicare VA Institutional Claim

Overview C N L

Processing a Medicare VA Institutional ClaimC/SIM N M

Processing a Medicare VA Professional Claim

Overview C N M

Processing a Medicare VA Professional ClaimC/SIM N M

Processing Medicare VA/MTF Claims

ACT N H


K. Pollard 22 of 69 10/14/2014



Impacted


SSD1317 Processing Medicare Rural Health Claims

Medicare Rural Health Claims Overview C N M

Processing a Professional Medicare Rural Health

Claim C/SIM N M

Processing Medicare Rural Health Claims

ACT N HSSD1318 Processing Medicare Physical Therapy Claims

Medicare Physical Therapy Claims Overview C N M

Processing a Professional Medicare Physical Therapy ClaimC/SIM N M

Processing Medicare Physical Therapy Claims

ACT N HSSD1371 FEPDirect (FEP Trainees Only)

FEPDirect Overview C N L

FEPDirect Retrieval: Conducting a Contract

Search C N L

FEPDirect Retrieval: Contract and Member

Enrollment C?SIM N M

FEPDirect Retrieval: Contract and Member Level

Special Information C/SIM N M

FEPDirect Scavenger Hunt ACT N LSSD1198 Paperless Inventory

Paperless Inventory Overview C N N/A

Paperless Inventory Demo ILT N N/AImage: Processing a Claim Using CMMouse and the Image System

Processing a Claim Using CMMouse and Image ILT N N/APati;ent Select

Patient Select (IPTX) Screen ILT N N/A

Member Inquiry Screen (CCSP) ILT N N/A

Pataient Select (GPSL) Screen ILT N N/ASSD1130 OINQ

Claim Image Online Inquiry (OINQ) OverviewC/SIM N H

SSD1130CCSP OINQ

Claim Image Online Inquiry (OINQ) OverviewC?SIM N H

SSD1178 BIS Claims

Processing a BIS Claim Overview C N L

Processing BIS Claims C/SIM N M

Activity: Working with BIS Claims (live work) ACT N N/ASSD1178CCSP BIS Claims

Processing a BIS Claim Overview C N L

Processing BIS Claims C/SIM N M

Activity: Working with BIS Claims (live work) ACT N N/A


K. Pollard 23 of 69 10/14/2014



Impacted


SSD1196 Inter-Plan for Home Claims

Inter-Plan Program Overview C N L

ITFI Overview C N MSSD1196CCSP Inter-Plan for Home Claims

Inter-Plan Program Overview C Y N/A

ITFI Overview C Y LSSD2189WBT01 Introduction to ITFI Mouse (Need to determine who owns)

Introduction to ITFI Mouse C N L

Working with ITFI for Submission Format (SF) Records ACT N L

Activity: Working with Inter-Plan Claims (live work) ACT N LSSD1372 State of Texas (SOT) Referrals (SOT Trainees Only)

SOT Referral Overview C N M

SOT Referrals: Verifying In-Network vs. Out of

Network Services C?SIM N H

SOT Referrals: Primary Care Physician (PCP) and

Back-up PCP Overview C?SIM N H

SOT Referrals: Determining Referral Submission

in KI00 C N M

SOT Referrals: Using the F4 Process C N M

SOT: Processing a Professional Medical Claim

with a Referral Prompt C/SIM N H

SOT: Processing a Professional Behavioral Health

Claim with a Referral Prompt C/SIM N H

SOT: Processing an Institutional Outpatient

Medical Claim with a Referral Prompt C/SIM N H

SOT: Processing an Institutional Inpatient

Hospital Stay Claim with a Pre-Certification

Prompt C/SIM N H

Activity: Working with SOT Claims (Live Work)ACT N L

Footnote: the forms do not impact the claims curricula as these are related to BlueCard Host transactions

LegendForms Impacted (ANSI 5010 Scope) Course Impact Level Impacted Type

270-271 Inquiry Eligibility H = High Impact - total overhaul of lesson ACT = Activity

276-277 Claims Status InquiryM = Medium Impact - Partial lesson changes

EX = Exercise

278 Precertification L = Low Impact - awareness only SIM = Simulation

834 Enrollment/ 820 Premium Bill NA = Not Applicable PF = Process Flow

835 Remittance HO = Handout

837 Claims/ NCPDP D.O. C = ConceptualJ = Job AidILT = Instructor Led TrainingFG = Facilitator Guide


K. Pollard 24 of 69 10/14/2014



Impacted


PG = Participant Guide


K. Pollard 25 of 69 10/14/2014


Comments

Replace images Update activityReplace images

Replace images Replace images in Storyboard and Sim.

Replace screen shotsReplace screen shots

Replace screen shotsReplace screen shots

Replace screen shots


Sim needs replacedSim needs replaced

Claim forms need replaced

Claim forms need replaced


K. Pollard 26 of 69 10/14/2014


Comments

Screen shots in Captivate need replaced




Claim forms and answer keys need revised,

scanned into image, and answer keys revised.


scanned into image, and answer keys revised.Sim needs replaced






K. Pollard 27 of 69 10/14/2014


Comments


scanned into image, and answer keys revised.Sim needs replaced





screen shots need replaced

sim need replacedscreens and sim needs replacedscreen shots need replaced

screens and sim needs replacedscreen shots need replaced

sim needs replaced

sim needs replaced

All claims need revised, rescanned, and answer

keys updated.

updates to screens shots, rollovers, etc.updates to assessment questions

total rewrite for GMCDtotal rewrite for GMCD



Replace imagesreplace simReplace images

Update activityUpdate activity


K. Pollard 28 of 69 10/14/2014


Comments


Replace sim

Replace test claims in Blue Chip







Replace screen shot

Slide 9 - replace GSVC screen

Replace sim



Revise claim, answer key, and rescan.



Replace sim


K. Pollard 29 of 69 10/14/2014


Comments



Replace claim form



Replace screen shot

Slide 9 - replace GSVC screen

Replace sim



Revise claim, answer key, and rescan.



Replace sim



Replace claim form






K. Pollard 30 of 69 10/14/2014


Comments

Replace sim


revise claim form, answer key, and rescan.







replace screen shots and captivate



replace screen shots and captivate








Replace Sim





Replace Sim


K. Pollard 31 of 69 10/14/2014


Comments





Replace screen shotsReplace sim












Replace claim form and sim



Replace claim form



Replace claim form



Replace screen shots and vignette


K. Pollard 32 of 69 10/14/2014


Comments





Replace sim and screen shots





Replace sim and screen shots





Replace screen shots and captivate





Replaece screen shots and captivate





Replace screen shots and claim form

Replace claim and rescan, update answer key




K. Pollard 33 of 69 10/14/2014


Comments

Replace screen shots and claim form

Replace claim and rescan, update answer key





scanned into image, and answer keys revised.Replace claim form





scanned into image, and answer keys revised.Replace claim form









Replace Simulation


Replace sim




K. Pollard 34 of 69 10/14/2014


Comments


Replace sim



Replace screen shots and vignetteReplace Sim



Replace screen shot

Replace screen shot

Replace sim

Replace SimRevise activiity

The sims needs updated with OINQ screen shots

with ICD10.

The sims needs updated with OINQ screen shots

with ICD10.




K. Pollard 35 of 69 10/14/2014


Comments

Replace screen shotsReplace screen shots and Captivate


Replace screen shotsRevise activty


Replace sim

Replace sim

Replace screen shots and vignetteReplace screen shots and vignette

Replace sim

Replace sim

Replace sim

Replace sim


K. Pollard 36 of 69 10/14/2014


Comments


K. Pollard 37 of 69 10/14/2014

ICD-10 Impact Analysis - EISM Curriculum


Impacted

Forms Impacted Impact Level Comments

Blue Health Intelligence (BHI) Overview

ACT L

This lesson mentions diagnostic categories.

Clickables may not need to be updated.

Blue Health Intelligence (BHI) Toolkit Webinar

ILT M

This webinar and its corresponding fac guide

show illustrations of reports that reference

diagnostic categories. Images may need to be

updated.

Blue Health Intelligence (BHI) Facilitator Guide

FG M

This webinar and its corresponding fac guide

show illustrations of reports that reference

diagnostic categories. Images may need to be

updated.

ECM eClient Training Lesson 1: Course OverviewN/A

Confirmed with ID, that ANSI5010 changes will

not affect this lesson.

ECM eClient Training Lesson 2: Installing and

Navigating eClient N/A



ECM eClient Training: Lesson 3: Searching

Documents N/A



ECM eClient Training Lesson 4: Routing

Documents N/A



ECM eClient Training Lesson 5: Viewing

Documents N/A



ECM eClient Training Lesson 6: Storing and

Editing Documents N/A



ECM eClient Training Lesson 7: Course Materials

and Evaluation N/A



SSD Work from Home Program: ECM Image

Explorer N/A



SSD Work from Home Program: ECM Image

Explorer User Guide



Enterprise Data Warehouse FundamentalsN/A



Introduction to DatabasesN/A



Enterprise Data WarehouseN/A



TeradataN/A



SQL Basics IN/A



SQL Basics IIN/A



ITG50374 EDW Fundamentals

SSD2196WBT01 Blue Health Intelligence

ITG20400 ECM eClient

SSD2961 ECM Image Explorer

247507926.xlsx.ms_office - EISM

K. Pollard 38 of 69 10/14/2014

ICD-10 Impact Analysis - EISM Curriculum


Impacted


SSD2196WBT01 Blue Health Intelligence SQL Basics IIIN/A



SQL Basics IVN/A



EDW Fundamentals AssessmentN/A



SSDxxxxManaged Metadata Environment

N/A



EISM1000WBT01Introduction to EISM Division

N/A



EISM1000WBT02Introduction to EISM Processes

N/A



EISM1000WBT03Records Management Policy

N/A



EISM1000WBT04Overview of EISM Systems

N/A



EISM2000ETL Mainframe Basics

N/A



EISM2001Zena Overview & Best Practices

N/A



EISM2002Unix

N/A



EISMxxxxApplication Development Fundamentals

N/A





276-277 Claims Status InquiryM = Medium Impact - Partial lesson changes

EX = Exercise




837 Claims/ NCPDP D.O. C = ConceptualJ = Job Aid

ILT = Instructor Led Training

FG = Facilitator Guide


Upcoming EISM Courses

247507926.xlsx.ms_office - EISM

K. Pollard 39 of 69 10/14/2014

ICD-10 Impact Analysis - SSD Technical Support Curriculum


Impacted


SSD1521WBT01 The Blue Chip Experience Overview N/A No Impact

SSD1521WBT01 The Blue Chip Experience: Introduction N/A No Impact

SSD1521WBT02The Blue Chip Experience: Registration and

Document Begin N/A No ImpactSSD1521WBT03 The Blue Chip Experience: Eligibility/Legacy N/A No ImpactSSD1521WBT04 The Blue Chip Experience: Eligibility/EEP N/A No Impact

SSD1521WBT05The Blue Chip Experience: Claim Adjudication

N/A No Impact

SSD1521WBT06The Blue Chip Experience: Service Adjudication

N/A No Impact

SSD1521WBT07The Blue Chip Experience: Claim Release and

Document Begin N/A No Impact

SSD1525WBT01 Introduction to Accumulators N/A No Impact

SSD1520WBT01 Introduction to Accumulators Part One N/A No ImpactSSD1520WBT02 Introduction to Accumulators Part Two N/A No Impact

SSD1524WBT01 Copay N/A No ImpactSSD1524WBT02 Deductible N/A No ImpactSSD1524WBT01 Coinsurance N/A No ImpactSSD1524WBT02 Maximums N/A No Impact

SSD1527WBT01 Copay Processes Part One N/A No ImpactSSD1527WBT02 Copay Processes Part Two N/A No ImpactSSD1527WBT03 Copay Processes Part Three N/A No Impact

SSD1528WBT01 Deductible Processes Part One N/A No ImpactSSD1528WBT02 Deductible Processes Part Two N/A No Impact

SSD1529WBT01 Coinsurance Processes N/A No Impact

SSD1530WBT01 Maximum Processes Part One N/A No ImpactSSD1530WBT02 Maximum Processes Part Two N/A No ImpactSSD1530WBT01 Maximum Processes Part Three N/A No Impact

SSD1526WBT01 Conversions Part One N/A No ImpactSSD1526WBT02 Conversions Part Two N/A No Impact

FEAK N/A No Impact

Manual Load N/A No Impact

Claim Aggregates N/A No Impact

Carryover Credit N/A No Impact

SSD1536: The Blue Chip Experience Overview

SSD1521: The Blue Chip Experience

SSD1525: Introduction to Accumulators

SSD1529: Coinsurance Advanced Processes

SSD1526: Accumulator Conversions

SSD1520: Introduction to Accumulators

SSD1524: Accumulator Mechanics

SSD1527: Copay Advanced Processes

SSD1528: Deductible Advanced Processes

SSD1530: Maximum Advanced Processes

SSD15XX: Other Accumulator Processes

247507926.xlsx.ms_office - SSD Tech

K. Pollard 40 of 69 10/14/2014



Impacted


SSD1536: The Blue Chip Experience OverviewReimbursement/Subrogation N/A No Impact

System Data Copy (SDC) N/A No Impact

National Carrier N/A No Impact

Calculation Method N/A No Impact

Reports? N/A No Impact

SSD2031 Introduction and COB Rules N/A No ImpactSSD2032 Special Situations N/A No ImpactSSD2033 TCAR, Positive CSQ N/A No Impact

SSD2034Letter Status Coded, Locating OI, Allowable

Expense N/A No ImpactSSD2035 BOB and Blue Card N/A No Impact

Introduction to COB N/A No Impact

Introduction to CDHP N/A No Impact

Introduction to CDHP N/A No Impact

CDHP HCA N/A No Impact

CDHP HSA N/A No Impact

CDHP FSA N/A No Impact

CDHP Processes N/A No Impact

CDHP Maintenance N/A No Impact

Introduction to Blue Transfer N/A No Impact

Introduction to Blue Transfer N/A No Impact

Realtime Processing N/A No Impact

Batch Processing N/A No Impact

Reconciliation N/A No Impact

Blue Transfer Maintenance N/A No Impact

N/A No Impact


270-271 Inquiry Eligibility

H = High Impact - total

overhaul of lesson ACT = Activity

276-277 Claims Status Inquiry

M = Medium Impact - Partial

lesson changes EX = Exercise

278 Precertification

L = Low Impact - awareness

only SIM = Simulation



837 Claims/ NCPDP D.O. C = Conceptual

SSDXXXX: Pricing

SSD2031-2035: COB

SSDXXXX: COB Overview

SSDXXXX: Introduction to CDHP

SSDXXXX: CDHP

SSDXXXX: Introduction to Blue Transfer

SSDXXXX: Blue Transfer


K. Pollard 41 of 69 10/14/2014



Impacted


SSD1536: The Blue Chip Experience Overview J = Job Aid





K. Pollard 42 of 69 10/14/2014

ICD-10 Impact Analysis - Inquiry CA Curriculum


Impacted


Intro to New Hire CA Course ILT No No N/ASSD1400 The Road to Concierge Customer Service

Welcome/Icebreaker Act No No N/A

Customer Expectations Act No No N/A

Defining the Customer C No No N/A

Role Play Act No No N/A

Importance of Customer Service Act No No N/A

Introduction to Concierge Customer Service C No No N/A

Enabler Activity (Part 1 & 2) Act No No N/A

Game Show Act No No N/A

Importance of Concierge Customer Service ILT No No N/A

Introduction to the Key Elements in the

Customer Advocate RoleC No No N/A

Tic Tac Toe Act No No N/A

Aging Society Listening Activity Act No No N/A

Paraphrasing Activity Act No No N/A

Memory Test Act No No N/A

Probing Questions ILT No No N/A

Colorful Customer Service Act No No N/A

Decision Making ILT No No N/A

Key Element Practice Act No No N/A

Overcoming Customer Service Hurdles C No No N/ASSD1200 Introduction to Inquiry Quality Standards

Quality Auditing Overview C No No N/A

Standard Operating Model (SOM) Overview C No No N/ASSD1201 Inquiry Overview

Telephone Inquiry Overview C No No N/A

Receiving a Telephone Inquiry Act No No N/A

Telephone Inquiry Terms and Metrics C No No N/ASSD1202 CA System Overview

Customer Advocate (CA) System Overview C No No N/A

Logging on and off Act No No N/ASSD1203 & SSD1382 Introduction to Dashboard

Dashboard Preview ILT No No N/A

Dashboard Overview and Guided Tour C No No N/A

Beginning a Telephone Inquiry in DashboardC No No N/A

Beginning a New Inquiry Activity Act No No N/A

SSD Talking About Privacy C No No N/A

Talking About Privacy ILT No No N/ASSD1204 CTI Softphone Telephone Basics

CTI Softphone Overview C No No N/A

Placing the Call on Hold, Making and Releasing a

CallSim No No N/A

Conference Transfer ILT No No N/A

247507926.xlsx.ms_office - Inquiry-CA

K. Pollard 43 of 69 10/14/2014



Impacted


After Call Work (ACW) ILT No No N/A

AUX Work ILT No No N/ASSD1205 Locating Membership and Claim Information in Dashboard

Membership and Claim Information in

DashboardC No No N/A

Where in Dashboard are BCBS Members? Act No No N/A

Locating Membership and Claim Information in

DashboardSim No No H

Sim needs updated.

Extracting and Updating Claim Information in

Dashboard ActivityAct No No N/A

SSD1206 Working with Service Requests and Activities in Dashboard

Service Request and Activity Overview C No No N/A

Documenting a Telephone Inquiry in Dashboard:

Effective Date Sim No No N/A

Requesting ID Cards ILT No No N/A

Documenting a Telephone Inquiry in Dashboard:

Claim DeniedSim No No N/A

Doc and Dash Act No No N/A

Modifying a Service Request Activity Act No No N/A

Reassigning a Service Request Activity Act No No N/ASSD1207 Monitoring and Working My Inventory

My Inventory Overview C No No N/A

Pending Possibilities ILT No No N/A

Working My Inventory Sim No No N/A

Resuming and Modifying a Service Request and

Activity in DashboardSim No No N/A

Closing a Service Request and Activity in My

Inventory ActivityAct No No N/A

Beginning a Telephone Inquiry Activity

Beginning a Telephone Inquiry - No Subscriber ID

AvailableAct No No N/A

Beginning a Telephone Inquiry - Claim Inquiry

and AlertAct No No N/A

Beginning a Telephone Inquiry - No MembershipAct No No N/A

Beginning a Telephone Inquiry - Incorrect

Membership InformationAct No No N/A

SSD1208 Introduction to Membership Inquiries

Introduction to Membership Inquiries C No No N/ASSD1209 Investigating Inquiries in BlueSTAR

BlueSTAR Inquiry Overview C No No N/A

BlueSTAR Inquiry: Members Level Overview C No No N/A

BlueSTAR Inquiry: Benefit Agreement and Group

Section WindowsC No No N/A

Verifying Eligibility in BlueSTAR Sim No No N/A


K. Pollard 44 of 69 10/14/2014



Impacted


SSD1210 Investigating Inquiries in Support Files

Customer Advocate (CA) Support File Overview:

ITOF, FSUI, TRSM, GRPIC No No N/A

Locating Office in FSUI and Phone Number in

TRSM and Working with GRPISim No No N/A

SSD1211 Investigating Inquiries in Blue Access for Members (BAM)

Blue Access for Members (BAM) Overview C No No N/A

Blue Access for Members (BAM) CA Application

OverviewC No No N/A

Working in BAM: Launch and Sign On to Blue

Access for Members (BAM) CA Application Sim No No N/A

Working in BAM: Members Without Internet

Access and Provider FinderSim No No N/A

SSD1212 Ordering New ID Cards in BlueSTAR and BAM

Identification Card Overview C No No N/A

Ordering ID Cards: BlueSTAR and BAM Sim No No N/ABeginning and Investigating Membership Telephone Inquiries Activity

Membership/Eligibility in BlueSTAR Address

ChangeAct No No N/A

Membership/Eligibility in BlueSTAR Dependents

and Student CertificationAct No No N/A

Membership/Eligibility in BlueSTAR New BabyAct No No N/A

Eligibility 2 Evaluation Act No No N/ASimulated Calls Round 1: Handling Membership and Eligibility Calls

Live Call Observation Act No No N/A

Evaulation Forms (Epps & Concierge) ILT No No N/A

Membership Eligibility in BlueSTAR: Dependents

and Student CertificationS CALLS No No N/A

Membership Eligibility in BlueSTAR: Address

ChangeS CALLS No No N/A

Membership Eligibility in BlueSTAR: New BabyS CALLS No No N/A

Simulated Call Round Debrief ILT No No N/ASSD1213 Introduction to Benefit Inquiries

Product Overview C No No N/A

Introduction to Benefit Inquiries, Quoting

Benefits and TerminologyC No No N/A

Fun with Fundamentals of Health Care ContractsILT No No N/A

SSD2039 & SSD2193 Real Time Benefits (RTB) for Members

RTB Preview ILT No No N/A

Real Time Benefits for Members C No No N/A


K. Pollard 45 of 69 10/14/2014



Impacted


Answering Member Benefit Inquiries Using RTBILT/ACT No No N/A

Real Time Feud ILT/ACT No No N/A

Inny, Minny, Miny, Mo…. Choose an RTB Benefit

by it's ToeILT/ACT No No N/A

Lightning Round ILT/ACT No No N/A

Benefit Quoting Procedures for Customer

AdvocatesC No No N/A

Responding to Benefit Inquiries ILT No No N/A

Basic Benefit Determination Act No No N/A

Specialized Benefit Determination Act No No N/A

Overall Benefit Review Act No No N/ASSD1216 IMNU Path 3: Patient Information and Accums

IMNU Path 3 Overview C No No N/A

Working with IMNU Path 3 ILT/ACT No No N/A

Hunt for Accums ILT/ACT No No N/A

Investigating Claim Inquires in IMNU Using Path

3Act No No N/A

Investigating Benefit Inquiries Activity

Ordering New ID cards, Printing Temporary ID

Cards, and Querying for Benefits in RTBAct No No N/A

Answering Benefit Inquiries:

Maternity/Obstetrical CareAct No No N/A

Simulated Calls Round 2: Handling Membership and Benefit Calls


Ordering New ID cards, Printing Temporary ID

Cards, and Querying for Benefits in RTBS CALLS No No N/A

Explaining an Explanation of Benefits and

sending a duplicate EOB to a member via BAM. S CALLS No No N/A

Answering Benefit Inquiries:

Maternity/Obstetrical CareS CALLS No No N/A

Simulated Call Center Activity Debrief ILT No No N/A

Benefits Evaluation Act No No N/A

"How are you doing Doing Benefit Touchpoint"

#1ILT No No N/A

SSD1214 Consumer-Directed Health Plans (CDHP)

Consumer-Directed Health Plans (CDHP) and

BlueEdge OverviewC No No N/A

BlueEdge Explaining HCA to Members C No No N/A

BlueEdge Heatlh Savings Account HSA C No No N/ASSD1215 Introduction to Claim Inquiries and IMNU

IMNU Preview ILT No No N/A

Introduction to Claim Inquiries C No No N/A

IMNU Overview C No No M Replace screenshot on storyboard


K. Pollard 46 of 69 10/14/2014



Impacted


SSD1224 IMNU Path 1 and 11: Claim Inquiry



Pulling Fields Out of a Hat ILT/ACT No No N/A

Investigating Claim Inquiries in IMNU Using Path

1Act No No N/A

SSD1225 IMNU Path 12 and FNID: Payments

Financial Payment Database Information Display

(FNID)C No No N/A


Working with IMNU Path 11, 12 and FNID

(Demo)ILT No No N/A

Locating the Lost Claim Information Act No No N/ASSD1226 IMNU Path 13, 17 and Document Direct: Research

DocumentDirect Overview C N/A

Document Direct: Responding to Explanation of

Benefit InquiriesILT No No N/A


Working with Path 13 Act No No N/A

IMNU Path 17 Overview C No No M Replace screenshot on storyboard

Working with Path 17 Act No No N/AInvestigating Claim Inquires in IMNU Activity

Investigating Claims in IMNU ILT No No N/A

Explain That Claim! Activity Act No No N/ASSD1217 DOL/ERISA

Department of Labor/Employee Retirement

Income Security Act (DOL/ERISA) OverviewC No No N/A

Identifying a DOL ERISA Appeal Activity C No No N/ASimulated Calls Round 3: Handling Claim Calls I


Working with IMNU Path 12 and FNID S CALLS No No N/A

Working with IMNU Path 3 and RTB S CALLS No No N/A

Working with IMNU Path 1 S CALLS No No N/A

Simulated Call Center Activity Debrief ILT No No N/ASSD1218 Investigating Medicare Claim Inquiries

Medicare Preview ILT No No N/A

Medicare Overview C No No N/A


Working with IMNU Path 15 ILT No No N/A

Medicare Calculations ILT No No N/A

Do the Math Act No No N/A

Medicare Scenarios Act No No N/A

Researching Medicare Claims ILT/Act No No N/A

Medicare Claim Status ILT No No N/A

Breaking Down Medicare Claim Payments Act No No N/A


K. Pollard 47 of 69 10/14/2014



Impacted


Investigating Medicare Claim Inquiries in IMNU Activity

Researching Medicare Claims in IMNU Act No No N/A

Verifying Eligibility and Researching Medicare

Claims in IMNU: Supplemental Benefits Act No No N/A

Claim Evaluation Act No No N/A

"How are you doing Doing Claim Inquiry

Touchpoint" #2 ClaimsILT No No N/A

SSD1227WBT01 Image Overview

Image Overview C No No M Replace images Simulated Calls Round 4: Handling Claim Calls II


**Working with IMNU Path 1 S CALLS No No N/A


Verifying Eligibility and Researching Medicare

Claims in IMNU: Supplemental Benefits S CALLS No No N/A

Simulated Call Center Activity Debrief ILT No No N/ASSD1219 CA Claim Adjustments

Claim Adjustment Overview C No No M Replace screenshot on storyboard

Request for Claim Refund (RFCR) Overview C No No N/A

Duplicate Simulation Sim No No H Sim needs updated.

Adjustment Demo ILT No No N/A

AAA An Adjustment Assessment Act No No N/A

Incorrect Provider Paid Simulation Sim No No H Sim needs updated.

IMNU Path 19 Overview C No No N/ASSD1220 Coordination of Benefits (COB)

COB Preview ILT No No N/A

Coordination of Benefits (COB) Overview C No No N/A

IMNU Filter C No No N/A

Locating COB Information C No No N/A

Coordination of Benefits Secondary Carrier Act No No N/A

Researching IMNU Activity Act No No N/AProcessing Claim Adjustments Activity

Processing Adjustments: Incorrect Patient

AdjustmentAct No No N/A

Processing Adjustments: Incorrect DiagnosisAct No No H Change the diagnosis code in activity

Processing Adjustments: Claim Disapproved for

No Medicare InformationAct No No N/A

Simulated Calls Round 5: Handling Membership, Claim and Benefit Calls I


Researching COB Payments in IMNU S CALLS No No N/A

Working with IMNU Path 11: Patient

ResponsibilityS CALLS No No N/A


K. Pollard 48 of 69 10/14/2014



Impacted


Researching Benefits in RTB: Preventive CareS CALLS No No N/A

Simulated Call Center Activity Debrief ILT No No N/ASSD1221 Premier Pricing and Cost Containment

PREMIER Procedure and Diagnosis Code Inquiry

OverviewC No No M

Lesson will need revised based on updates for

Premier to list ICD10.

Adjudication Indicator Bits for Emergency and

Claim Paid Out-Of-NetworkSim No No M

Sim needs updated.

PFIN and Cost Containment Inquiry File

OverviewC No No M

Lesson will need revised based on updates for

Premier to list ICD10.Premier Pricing and Cost Containment Activity

Cost Containment ILT No No N/A

Premier Pricing: Emergency Act No No N/A

Claim paid out-of-network Act No No N/A

Locating a PPO Provider using Blue Access for

Members and Querying for X-Ray benefits Act No No N/A

SSD1222 BlueCard

BlueCard Preview ILT No No N/A

Inter-Plan Program Overview C No No N/A

Inter-Plan Business Components C No No N/A

BlueCard or Bust! An ITS Game Act No No N/A

Identifying ITS Claims ILT No No N/A

Introduction to ITFI C No No N/A

Introduction to ITFI ILT No No N/A

Formats Selection (ITFI) Screen ILT No No N/A

Back to Basics- Basic Navigation of ITFI ILT No No N/A

Streamline Adjustments C No No N/A

ITS Servicing Principles C No No N/A

Inter-Pearl Plan Processing and Inquiry Support

FilesC No No M Replace screenshot on storyboard

HCSC BlueCard Claims: Switching Blue Chip

RegionsAct No No N/A

Comprehensive Activity Act No No N/A

Following the Blue Brick Road Act No No N/ASSD2500_FOR VERSION_3.1BlueSquared Basics

BlueSquared Overview C No No N/A

BlueSquared Message Types Overview C No No N/A

Researching BlueSquared C No No N/A

BlueSquared Basics Worksheet Act No No N/ASSD2085WBT01 & SSD1470 Preexisting Conditions (PEC)

Preexisting Conditions (PEC) Overview C No No M Replace screenshot on storyboard

Investigating Preexisting Conditions (PEC)

InquiriesC No No M Replace screenshot on storyboard


K. Pollard 49 of 69 10/14/2014



Impacted


Folder Notes (FNOTS) on IMAGE for Preexisting

ConditionsILT No No N/A

Preexisting Activity Act No No N/ASimulated Calls Round 6: Handling Membership, Claim and Benefit Calls II


**Membership: Eligibility New ID Cards S CALLS No No N/A

Locating a PPO Provider using BAM and

Querying for Routine Colonoscopy and MRI

Benefits

S CALLS No No N/A

Researching ITFI for Correct Patient S CALLS No No N/A

Simulated Call Center Activity Debrief ILT No No N/ASSD1223 Letter Generation

Letter Generation Overview C No No N/A

2Working with Letter Generation: Operative and

Emergency Room ReportSim No No N/A

Bringing it all Together Activity

Working with ITFI on a Professional Claim

Inquiry: SF, DF, RFAct No No N/A

Working with ITFI on an Institutional Claim

Inquiry: SF, DF, RFAct No No N/A

Working with IMNU Path 11 Act No No N/A

Answering Benefit Inquiries: Routine Well CareAct No No N/A

Researching Medicare Claims in IMNU Act No No N/A

Working with IMNU Path 3 Act No No N/A

Coordination of Benefits TCHI Act No No N/A

Ordering New ID Cards and Locating Dependent

InformationAct No No N/A

Simulated Calls Round 7: Handling Membership, Claim and Benefit Calls III



Obtaining the Correct 800 Number Using TRSMS CALLS No No N/A

Investigating Inquiries in BlueSTAR and RTBS CALLS No No N/A

Simulated Call Center Activity Debrief ILT No No N/AAuditing and Standard Operating Model Procedures

Auditing and Standard Operating Model

ProceduresILT No No N/A

Legends and Legacies Act No No N/AFSU Site Specific Book of Business

ILT ILT No No N/ATaking Live Calls in the Classroom

Live Live No No N/A


K. Pollard 50 of 69 10/14/2014



Impacted





M = Medium Impact - Partial lesson changes

EX = Exercise





J = Job Aid





K. Pollard 51 of 69 10/14/2014

ICD-10 Impact Analysis - Provider Curriculum


Impacted


All NA

Quality Auditing Overview NAStandard Operating Model Overview NA

Inquiry Overview NAReceiving a Telephone Inquiry Overview NATelephone Inquiry Terms and Metrics NA

CA System Overview NA

BlueSource Overview NABlueSource Activity NA

NPI Overview for Provider Customer Service NA

Dashboard Overview and Guided Tour NA

Beginning a Telephone Inquiry in Dashboard NABeginning a New Inquiry Activity NA

CTI Softphone Overview NAPlacing the Call on Hold, Making & Releasing a

Call NA

Membership and Claim Information in

Dashboard NALocating Membership and Claim Information in

Dashboard NA

Service Requests and Activites Overview NADocumenting a Telephone Inquiry in Dashboard:

Effective Date NADocumenting a Telephone Inquiry in Dashboard:

Claim Denied NA

My Inventory Overview NAWorking My Inventory NAResuming & Modifying a Service Request and

Activity in Dashboard NA

Customer Advocate (CA) Audio Data Entry I NACustomer Advocate (CA) Audio Data Entry II NA

SSD2095 National Provider Identifier (NPI) for Provider Customer Service

SSD1400 The Road to Concierge Customer Service

SSD1240 New Hire Training for Provider Customer Advocates: Introduction to Inquiry Quality Standards

SSD1241 New Hire Training for Provider Customer Advocates: Inquiry Overview

SSD1242 New Hire Training for Provider Customer Advocates: Logging On and Off

SSD1243 New Hire Training for Provider Customer Advocates: Introduction to BlueSource

SSD1244 New Hire Training for Provider Customer Advocates: Introduction to Dashboard

SSD1036 Customer Advocate Audio Data Entry

SSD1245 New Hire Training for Provider Customer Advocates: Softphone Telephone Basics

SSD1246 New Hire Training for Provider Customer Advocates: Locating Membership and Claim Information in Dashboard

SSD1247 New Hire Training for Provider Customer Advocates: Working with Service Requests and Activites in Dashboard

SSD1248 New Hire Training for Provider Customer Advocates: Monitoring and Working My Inventory

247507926.xlsx.ms_office - Provider

K. Pollard 52 of 69 10/14/2014



Impacted


SSD1400 The Road to Concierge Customer ServiceCustomer Advocate (CA) Audio Data Entry III NACustomer Advocate (CA) Audio Data Entry IV NACustomer Advocate (CA) Audio Data Entry V NACustomer Advocate (CA) Audio Data Entry VI NA

Introduction to Membership/Eligibility Inquiries NA

BlueSTAR Inquiry Overview NABlueSTAR Inquiry - Members Level Overview NABlueSTAR Inquiry - Benefit Agreement and

Group Section Overview NA

Provider File Inquiry (PFIN) Overview NAPCA Support File Overview - ITOF, GRPI, and

GMBF NA

Consumer -Directed Health Plans (CDHP):

Overview NAConsumer -Directed Health Plans (CDHP):

Explaining HCA to Members NAConsumer-Directed Health Plans (CDHP):

Explaining HSA to Members NA

Blue Access for Members (BAM) Overview NA

Introduction to Benefit Inquiries, Quoting

Benefits and Terminology NABenefit Inquiry Systems Overview NA

WBT01 Procedure and Diagnosis Code Inquiry Overview NASearching for Procedure and Diagnosis Codes in

PREMIER - Activity FG/ACT 276/277 M

Medical Policy Manual Overview NA

Real Time Benefits (RTB) for Provider NAAnswering Benefit Inquiries (RTB) Activity NA

IMNU Path 3 Overview NAWorking with IMNU Path 3 NA

Referral and Pre-Authorization Overview NA

SSD1254 New Hire Training for Provider Customer Advocates: Investigating Benefit Inquiries in PREMIER

SSD1258 New Hire Training for Provider Customer Advocates: Referral and Pre-Authorization Inquiries

SSD1249 New Hire Training for Provider Customer Advocates: Introduction to Eligibility Inquiries

SSD1250 New Hire Training for Provider Customer Advocates: Investigating Inquiries in BlueSTAR

SSD1251 New Hire Training for Provider Customer Advocates: Investigating Inquiries in Support Files

SSD1214 Consumer-Driven Health Plans (CDHP)

SSD1252 New Hire Training for Provider Customer Advocates: Investigating Inquiries in Blue Access for Members (BAM)

SSD1253 New Hire Training for Provider Customer Advocates: Introduction to Benefit Inquiries

SSD1256 New Hire Training for Provider Customer Advocates: Investigating Benefit Inquiries in Medical Policy Manual

SSD2038 Real Time Benefits (RTB) for Providers

SSD1257 New Hire Training for Provider Customer Advocates: Investigating Benefit Inquiries in IMNU

SSD1259 New Hire Training for Provider Customer Advocates: Inquiries - Legislation


K. Pollard 53 of 69 10/14/2014



Impacted


SSD1400 The Road to Concierge Customer ServiceAIM and RQI Overview NA

Introduction to Claim Inquiries and Terminology NAClaim Form Overview NAPractice Activity: Claim Forms FG/ACT 276/277/837 M

WBT01 Image Overview C 276/277 L

WBT01 Blue Chip Overview C 276/277 LProcessing Professional Claims ILT/ACT 276/277 HProcessing Institutional Claims ILT/ACT 276/277 H

WBT01 IMNU Overview C 276/277 MIMNU Path 1 Overview NA

Practice Activity: Working with IMNU Path 1 NAWBT03 IMNU Path 11 Overview C 276/277 M

Practice Activity: Working with IMNU Path 11 NA

IMNU Path 12 Overview C Yes NA


IMNU Path 13 Overview C Yes NA


SSD1266 New Hire Training for Provider Customer Advocates: Investigating Claim Inquiries in IMNU IIIIMNU Path 16 Overview C 276/277 LIMNU Path 17 Overview C 276/277 LPractice Activity: Working with IMNU Path 16

and Path 17 NA

IMNU Path 18 Overview NAIMNU Path 19 Overview NAPractice Activity: Working with IMNU Path 18

and Path 19 NACSA - Practice Activity: Working with IMNU Path

18 and Path 19 NAWBT03 Claim Status Inquiry Overview C 276/277 L

Practice Activity: All IMNU Paths NA

WBT01 Document Direct Overview C 276/277 M

SSD1261 New Hire Training for Provider Customer Advocates: Viewing Claims - Image

SSD1262 New Hire Training for Provider Customer Advocates: Introduction to Claim Processing

SSD1263 New Hire Training for Provider Customer Advocates: Investigating Claim Inquiries in IMNU I

SSD1268 New Hire Training for Provider Customer Advocates: Viewing Claims - Document Direct and OINQ

SSD1267 New Hire Training for Provider Customer Advocates: Investigating Claim Inquiries in IMNU IV

SSD1264 New Hire Training for Provider Customer Advocates: Investigating Claim Inquiries in IMNU II

SSD1260 New Hire Training for Provider Customer Advocates: Introduction to Claim Inquiries


K. Pollard 54 of 69 10/14/2014



Impacted


SSD1400 The Road to Concierge Customer ServiceDisplaying In Document Direct NA

Displaying and Working with Claim in OINQ NA

PREMIER Pricing Overview C Yes 276/277 MVerifying Pricing in PREMIER - Activity NA

WBT01 Medicare Overview C Yes NAMedicare Professional Claim and Attachments

Overview NA

WBT03

Medicare Institutional Claim, Attachment and

Value & Investigation Codes C Yes NAIMNU Path 15 Overview NA


Coordination of Benefits (COB) Overview NAWBT02 TCHI Overview C Yes NA

Practice Activity: Coordination of Benefits (COB) NA

WBT01 Letter Generation Overview C Yes NAWorking with Letter Generation: Operative and

Emergency Room Report NA

WBT01 Claim Delays and Denials Overview C 276/277 M

WBT02

Claim Delays and Denials - Pre-existing

conditions and Waiting Periods and COB C/SIM 276/277 M

WBT03

Claim Delay or Denial due to Provider

Investigation or Fraud Investigation C Yes NAPractice Activity - Handling Inquiries - Claim

Delays and Denials ACT 276/277 L

Investigating Claim Payments Overview (ILT) NARequest for Claim Refund (RFCR) Overview NA

Practice Activity - Investigating Claim Payments ACT 276/277 L

BlueCard Fundamentals (ILT) NAIMNU Path 9 Overview NA


SSD1274 New Hire Training for Provider Customer Advocates: Delays and Denials

SSD1275 New Hire Training for Provider Customer Advocates: Investigating Claim Payments

SSD1272 New Hire Training for Provider Customer Advocates: BlueCard Fundamentals

SSD1276 New Hire Training for Provider Customer Advocates: Claim Adjustments

SSD1273 New Hire Training for Provider Customer Advocates: Letter Generation

SSD1271 New Hire Training for Provider Customer Advocates: Coordination of Benefits (COB)

SSD1269 New Hire Training for Provider Customer Advocates: Investigating Claim Inquiries in PREMIER

SSD1270 New Hire Training for Provider Customer Advocates: Medicare Fundamentals


K. Pollard 55 of 69 10/14/2014



Impacted


SSD1400 The Road to Concierge Customer ServiceClaim Adjustment Overview C Yes 276/277/837 MProcessing Adjustments - Incorrect Provider Paid

and Incorrect Charges C/SIM 276/277/837 MProcessing Adjustments - Incorrect Diagnosis

and COB Adjustment C/SIM 276/277/837 M

Practice Activity - Processing Adjustments ACT 276/277/837 L

Handouts FG/PG 276/277/837 M

Forms Impacted (ANSI 5010 Scope) Course Impact Level Impacted Type


276-277 Claims Status Inquiry M = Medium Impact - Partial lesson changes EX = Exercise





J = Job Aid




Handouts Section


K. Pollard 56 of 69 10/14/2014


Comments

shared with Member CA

SSD2095 National Provider Identifier (NPI) for Provider Customer Service


SSD1240 New Hire Training for Provider Customer Advocates: Introduction to Inquiry Quality Standards

SSD1241 New Hire Training for Provider Customer Advocates: Inquiry Overview

SSD1242 New Hire Training for Provider Customer Advocates: Logging On and Off

SSD1243 New Hire Training for Provider Customer Advocates: Introduction to BlueSource

SSD1244 New Hire Training for Provider Customer Advocates: Introduction to Dashboard

SSD1036 Customer Advocate Audio Data Entry

SSD1245 New Hire Training for Provider Customer Advocates: Softphone Telephone Basics

SSD1246 New Hire Training for Provider Customer Advocates: Locating Membership and Claim Information in Dashboard

SSD1247 New Hire Training for Provider Customer Advocates: Working with Service Requests and Activites in Dashboard

SSD1248 New Hire Training for Provider Customer Advocates: Monitoring and Working My Inventory


K. Pollard 57 of 69 10/14/2014


Comments





Replace ICD examples

SSD1254 New Hire Training for Provider Customer Advocates: Investigating Benefit Inquiries in PREMIER

SSD1258 New Hire Training for Provider Customer Advocates: Referral and Pre-Authorization Inquiries

SSD1249 New Hire Training for Provider Customer Advocates: Introduction to Eligibility Inquiries

SSD1250 New Hire Training for Provider Customer Advocates: Investigating Inquiries in BlueSTAR

SSD1251 New Hire Training for Provider Customer Advocates: Investigating Inquiries in Support Files

SSD1214 Consumer-Driven Health Plans (CDHP)

SSD1252 New Hire Training for Provider Customer Advocates: Investigating Inquiries in Blue Access for Members (BAM)

SSD1253 New Hire Training for Provider Customer Advocates: Introduction to Benefit Inquiries

SSD1256 New Hire Training for Provider Customer Advocates: Investigating Benefit Inquiries in Medical Policy Manual

SSD2038 Real Time Benefits (RTB) for Providers

SSD1257 New Hire Training for Provider Customer Advocates: Investigating Benefit Inquiries in IMNU

SSD1259 New Hire Training for Provider Customer Advocates: Inquiries - Legislation


K. Pollard 58 of 69 10/14/2014


Comments


Replace ICDs on claim examples

Replace screen shots of claim form with ICD

Replace screen shots of processing screensReplace claim samples usedReplace claim samples used

Replace screen shots of claims screen


keywords "Blue Chip Draft Display (IDFD) Screen"

keywords "Blue Chip Claim Status (ISTD) Screen"

Replace screen shots of claims screenReplace screen shots of claims screen


Replace screen shots of claim form with ICD

SSD1261 New Hire Training for Provider Customer Advocates: Viewing Claims - Image

SSD1262 New Hire Training for Provider Customer Advocates: Introduction to Claim Processing

SSD1263 New Hire Training for Provider Customer Advocates: Investigating Claim Inquiries in IMNU I

SSD1268 New Hire Training for Provider Customer Advocates: Viewing Claims - Document Direct and OINQ

SSD1267 New Hire Training for Provider Customer Advocates: Investigating Claim Inquiries in IMNU IV

SSD1264 New Hire Training for Provider Customer Advocates: Investigating Claim Inquiries in IMNU II

SSD1260 New Hire Training for Provider Customer Advocates: Introduction to Claim Inquiries


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Comments


Replace screen shots of claim forms with ICD

keywords "Medicare Rates and Benefit Periods"

keywords "Value Code UB"

keywords "Duplicate Coverage Source Codes"

keywords "Launching Letter Generation"

Replace screen shots of claims screens

Replace screen shots of claims screens

keywords "Hold Codes"Just need to make sure that PS has updated claim

examples

Just need to make sure that PS has updated claim

examples

SSD1274 New Hire Training for Provider Customer Advocates: Delays and Denials

SSD1275 New Hire Training for Provider Customer Advocates: Investigating Claim Payments

SSD1272 New Hire Training for Provider Customer Advocates: BlueCard Fundamentals

SSD1276 New Hire Training for Provider Customer Advocates: Claim Adjustments

SSD1273 New Hire Training for Provider Customer Advocates: Letter Generation

SSD1271 New Hire Training for Provider Customer Advocates: Coordination of Benefits (COB)

SSD1269 New Hire Training for Provider Customer Advocates: Investigating Claim Inquiries in PREMIER

SSD1270 New Hire Training for Provider Customer Advocates: Medicare Fundamentals


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Comments

SSD1400 The Road to Concierge Customer Service Replace screen shots of adjustment screens

Replace screen shots of adjustment screens

Replace screen shots of adjustment screensJust need to make sure that PS has updated claim

examples

Replace screen shots and claim forms examples

Handouts Section


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ICD-10 Impact Analysis - Examiner Curriculum


Impacted


SSD2081WBT01 Basic Examiner OverviewSSD2081WBT02 Product OverviewSSD2081WBT03 Examiner Tools: Inquiry Support Files

SSD2081WBT04Examiner Tools: Inquiry Begin Menu IMNU Fields

and Screens C M

SSD2081WBT05Examiner Tools: Inquiry Begin Menu Filter

C MSSD2081WBT06 Examiner Tools: Advanced BlueSTAR

SSD2081WBT07Examiner Tools: Introduction to

LetterGenerationSSD2081WBT08 Image for Examiners

SSD2081WBT09PREMIER Procedures and Diagnosis

C MSSD2186 PREMIER Pricing Inquiry

SSD2082WBT01 Adjustments Overview

SSD2082WBT02Late Charges and Corrected Claims

C M

SSD2082WBT03Request for Claim Refund (RFCR)

C M

Inter-Plan Program OverviewInter-Plan Business ComponentsIdentifying Inter-Plan Teleprocessing Services

(ITS) ClaimsFormats Selection Screen (ITFI) OverviewBasic Navigation of ITFI

SSD2189WBT01 ITFI Mouse

SSD2370 SIRF Mouse

SSD2500WBT01 BlueSquared (Blue2) OverviewSSD2500WBT02 BlueSquared Message Types OverviewSSD2500WBT03 Researching BlueSquared (Blue2)SSD2500WBT04 Enterprise Content Management (ECM)SSD2500WBT06 BlueSquared Informational MessageSSD2500WBT07 BlueSquared General Inquiry MessagesSSD2500WBT08 BlueSquared Medical Records Requests

SSD252- Standard NF Adjustments

SSD2521 Streamline Adjustments

<<SSD2500 BlueSquared>>

<<SSD2081 - Introduction to Examiner>>

<<SSD2082 - Adjustments>>

<<SSD2078 - Inter-Plan>>

<<SSD2189WBT01 - ITFI Mouse>>

<<SSD2370 - SIRF Mouse>>

<<SSD2520 Standard NF Adjustments>>

<<SSD2521 Streamline Adjustments>>

<<SSD2086 Cost Containment>>

247507926.xlsx.ms_office - Examiner

K. Pollard 62 of 69 10/14/2014



Impacted


<<SSD2081 - Introduction to Examiner>>SSD2086WBT01 Cost Containment Overview

SSD2086WBT02Cost Containment Inquiry File KI00 Overview

C M

SSD2086WBT03

Cost Containment Medical Services Advisory

(MSA)C M

SSD2086WBT04

Cost Containment Mental Health Substance

Abuse (MHC)

C MSSD2086WBT05 Cost Containment Guided Simulations

SSD2084WBT01Durable Medical Equipment (DME) Overview

SSD2084WBT02Durable Medical Equipment (DME) Rental

Overview C M

SSD2084WBT03Durable Medical Equipment (DME) Purchase

Overview C M

SSD2084WBT04Obtaining Durable Medical Equipment (DME)

Purchase Price in PREMIERSSD2084WBT05 Durable Medical Equipment (DME) BackendSSD2084WBT06 BlueCard and DME

SSD2084WBT07Durable Medical Equipment (DME) Guided

Simulations

SSD2085WBT01Preexisting Condition (PEC) Overview

C MSSD2085WBT02 Preexisting Condition (PEC) Frontend

SSD2085WBT03Preexisting Condition (PEC) Ologist Exception

SSD2085WBT04 Preexisting Condition (PEC) Backend C MSSD2085WBT05 BlueCard and PEC

SSD2085WBT06Preexisting Condition (PEC) Guided Simulations

SSD2031WBT01Introduction to Coordination of Benefits (COB)

SSD2031WBT02 Rule 1 NonDependent Dependent

SSD2031WBT03Rule 2 Dependent Child: Parents Not Separated

or Divorced

SSD2031WBT04Rule 3 Dependent Child: Parents Separated or

DivorcedSSD2031WBT05 Rule 4 Active and Inactive EmployeeSSD2031WBT06 Rule 5 Continuation Coverage

<<SSD2031 COB Introduction and COB Rules>>

<<SSD2084 Durable Medical Equipment (DME)>>

<<SSD2085 Preexisting Condition (PEC)>>


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Impacted



SSD2031WBT07Rule 6 Longer and Shorter Length of Coverage

SSD2032WBT01Special Coordination of Benefits (COB) Situations

SSD2032WBT02Coordination of Benefits (COB) Scenario

Assessment

SSD2032WBT03COB Support Files: COB History File Index and

Maintenance Overview

SSD2032WBT04COB Codes: Third Party Liability (TPL) and

Investigation (INV)

SSD2032WBT05

Claim Flow Through COB IMNU Filter or IMNU

Path 5C M

SSD2032WBT06Negative Other Insurance (OI) COB Subscriber

Questionnaire (CSQ)

SSD2033WBT01COB Support Files Carrier File Alpha Find TCAR

SSD2033WBT02COB Positive Other Insurance Customer Service

QuestionnaireSSD2033WBT03 COB Positive OI CSQ Generic TCHM UpdateSSD2033WBT04 COB Positive OI CSQ - Guided Simulations

SSD2034WBT01Coordination of Benefits (COB) Letter Status

CodesSSD2034WBT02 Locating Other Insurance (OI) InformationSSD2034WBT03 Allowable Expense Calculations

SSD2035WBT01Blue-on-Blue (BOB) Claims Processing:

InvestigationSSD2035WBT02 Blue-on-Blue (BOB) Claims ProcessingSSD2035WBT03 BlueCard Home COB Claims Processing

SSD2035WBT04BlueCard Home COB Claims Processing: Inter-

Pearl Plans




M = Medium Impact - Partial lesson changes

EX = Exercise




837 Claims/ NCPDP D.O. C = ConceptualJ = Job Aid

<<SSD2035 Coordination of Benefits (COB): Blue-on-Blue (BOB) and Blue Card>>

<<SSD2032 COB: Special Situations, TCHI/TCHM, TPL/INV, IMNU Filter, Negative CSQ>>

<<SSD2033 COB: TCAR, Positive CSQ>>

<<SSD2034 COB: Letter Status Codes, Locating OI, Allowable Expense>>


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Impacted


<<SSD2081 - Introduction to Examiner>> ILT = Instructor Led TrainingFG = Facilitator GuidePG = Participant Guide


K. Pollard 65 of 69 10/14/2014


Comments

No ImpactNo ImpactNo Impact

Slide 7 screen print (path 17) - InstitutionalSlides 4, 5, 6, Q4 - IMNU filter - is DIAG box going

to be updated?No Impact

No ImpactNo ImpactSlide 5 refers to ICD9, slides 7, 9, 10 show ICD9 dx

codeNo Impact

No ImpactSlide 5 has GZA5 screen print showing dx code

(Inst)

Slide 14 has GCLD screen print showing dx code

No ImpactNo Impact


No Impact

No Impact

No ImpactNo ImpactNo ImpactNo ImpactNo ImpactNo ImpactNo Impact

No Impact

No Impact

<<SSD2500 BlueSquared>>


<<SSD2082 - Adjustments>>

<<SSD2078 - Inter-Plan>>

<<SSD2189WBT01 - ITFI Mouse>>

<<SSD2370 - SIRF Mouse>>

<<SSD2520 Standard NF Adjustments>>

<<SSD2521 Streamline Adjustments>>

<<SSD2086 Cost Containment>>


K. Pollard 66 of 69 10/14/2014


Comments

<<SSD2081 - Introduction to Examiner>> No ImpactSlide 5 (flash file) shows KIMH screen with ICD9 dx

codes - prof

Slide 4 shows KI12 sceen with ICD9 dx codes, slide

9 shows GZA7 screen with ICD9 dx code - both instSlide 3 (flash file) shows KIMH screen w/ICD9 dx

codes (prof), slide 6 - KIMH screen w/ICD9 dx

codes (prof), slide 11 (flash file) shows GZA7

screen w/ICD9 dx code, slide 12 shows GZAH

screen w/ICD9 dx codesN/A - retiring or updating in different format

No ImpactSlide 6 - (flash file) GZA5 screen w/ICD9 dx code

(prof)Slide 6 - (flash file) GZA5 screen w/ICD9 dx code

(prof)


N/A - retiring or updating in different format

Slide 6 (flash file) - IMNU Filter, PREMIER, FNOT,

ITFINo Impact

No ImpactSlide 7 - FNOT screen shot w/ICD9 dx codeNo Impact

N/A - retiring or updating in different format

No ImpactNo Impact

No Impact


<<SSD2031 COB Introduction and COB Rules>>

<<SSD2084 Durable Medical Equipment (DME)>>

<<SSD2085 Preexisting Condition (PEC)>>


K. Pollard 67 of 69 10/14/2014


Comments


No Impact

No Impact

No Impact

No Impact

No ImpactSlide 4 (flash file) screen shot of IMNU filter. If

filter changes due to length of dx code, the screen

shot will be replaced.

No Impact

No Impact




No Impact

<<SSD2035 Coordination of Benefits (COB): Blue-on-Blue (BOB) and Blue Card>>

<<SSD2032 COB: Special Situations, TCHI/TCHM, TPL/INV, IMNU Filter, Negative CSQ>>

<<SSD2033 COB: TCAR, Positive CSQ>>

<<SSD2034 COB: Letter Status Codes, Locating OI, Allowable Expense>>


K. Pollard 68 of 69 10/14/2014


Comments



K. Pollard 69 of 69 10/14/2014