In response to MD Harun
Rashid's request, I am again giving an example of Dental Claim which is similar
to Real Life Scenario. The test case name is Oral Surgery. These are the steps that you are supposed to perform to process a dental claim in Facets under medical
plan.
Step 1: Open Test Lab Module of
ALM, you will see the following test case in test lab module of ALM/QC.
Test Case description: Process a claim for Oral Surgery
services using following data: INN Provider 333444555777 (Dental Surgeon), POS
11, HCPCS D7240, Subscriber ID-100200300, Diagnosis code ICD10: k08499,
Charges (PCP's Fee) $350, Unit 1(One Time Visit).
Expected Result: Claim should apply a
Copayment of $50 , then process at 80% of the allowable.
Step 2: Open Facets Claims
Processing application group and scroll down to Dental Claims processing
application.
Step 3: In the Indicative page
of Medical Claims processing application, enter the following data: Subscriber
ID and select a member from the drop down menu, Claim Received Date(suppose Jan
25, 2017), Provider ID and Diagnosis code.
Step 4: Now double click on
Line Item page and when you are in Line Item page, enter the following data:
Date of service (suppose Jan 20, 2017), POS, HCPCS code, Charges(suppose $350),
Unit(suppose 1), Total charges(Suppose $350).
Step 5: Press F3 on your
keyboard to process the claim. Now check the claim pricing.
Step 6: If the claim applies a
copayment of $50 as expected and then process at 80% of the allowable, save the
claim by pressing F4 on your keyboard. Facets will generate a claim ID
automatically. Suppose the claim ID is 000011112222
Step7: Open Lab module of ALM,
take required screenshots and type as follows in actual result edit box:
Claim processed as
expected and write the claim ID and pass the test case.
Note: HCPCS stands for
Healthcare Common Procedure Coding System.
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