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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
Data Field expansion and version idicator
added; Implementing ICD10 Lesson will
cover this
2 Actuarial & Underwriting Provider Cost and Utiliation w n/a n/a
Data Field expansion and version idicator
added; Implementing ICD10 Lesson will
cover this
2 Actuarial & Underwriting Provider Settlement Database w 1/27/2012 9/13/2012 165
Data Field expansion and version idicator
added; Implementing ICD10 Lesson will
cover this
2 Actuarial & Underwriting Self Service Reporting w 4/2/2012 7/31/2012 87
Data Field expansion and version idicator
added; Implementing ICD10 Lesson will
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
ICD10 Master Training Activity Plan
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
ICD10 Master Training Activity Plan
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
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We
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Job
Cat
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ICD
-10
Ove
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Imp
lem
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ICD
-10
: K
ey
Bu
sin
ess
De
cisi
on
s fo
r U
nd
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tan
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g th
e
Tran
slat
ion
of
ICD
-9 t
o IC
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toco
de
r
Re
pla
cem
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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
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ICD
-10
Ove
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ICD
-10
Tal
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/We
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Pre
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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
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Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
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Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
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ICD-10 Impact Analysis - Claims Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
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Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
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ICD-10 Impact Analysis - Claims Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
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ICD-10 Impact Analysis - Claims Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
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Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
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ICD-10 Impact Analysis - Claims Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
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ICD-10 Impact Analysis - Claims Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
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ICD-10 Impact Analysis - Claims Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
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Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
PG = Participant Guide
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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
Replace screen shots
Sim needs replacedSim needs replaced
Claim forms need replaced
Claim forms need replaced
247507926.xlsx.ms_office - Claims
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ICD-10 Impact Analysis - Claims Curriculum
Comments
Screen shots in Captivate need replaced
Screen shots in Captivate need replaced
Screen shots in Captivate need replaced
Screen shots in Captivate need replaced
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.Sim needs replaced
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
247507926.xlsx.ms_office - Claims
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ICD-10 Impact Analysis - Claims Curriculum
Comments
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.Sim needs replaced
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
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
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace imagesreplace simReplace images
Update activityUpdate activity
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ICD-10 Impact Analysis - Claims Curriculum
Comments
Replace screen shots
Replace sim
Replace test claims in Blue Chip
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace screen shots
Replace screen shots
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace screen shot
Slide 9 - replace GSVC screen
Replace sim
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Revise claim, answer key, and rescan.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace sim
247507926.xlsx.ms_office - Claims
K. Pollard 29 of 69 10/14/2014
ICD-10 Impact Analysis - Claims Curriculum
Comments
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace claim form
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace screen shot
Slide 9 - replace GSVC screen
Replace sim
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Revise claim, answer key, and rescan.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace sim
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace claim form
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace screen shots
Replace screen shots
247507926.xlsx.ms_office - Claims
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ICD-10 Impact Analysis - Claims Curriculum
Comments
Replace sim
Replace screen shots
revise claim form, answer key, and rescan.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
replace screen shots and captivate
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
replace screen shots and captivate
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace screen shots
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace Sim
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace Sim
247507926.xlsx.ms_office - Claims
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ICD-10 Impact Analysis - Claims Curriculum
Comments
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace screen shotsReplace sim
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace screen shots
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace screen shots
Replace screen shots
Replace claim form and sim
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace claim form
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace claim form
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace screen shots and vignette
247507926.xlsx.ms_office - Claims
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Comments
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace sim and screen shots
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace sim and screen shots
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace screen shots and captivate
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replaece screen shots and captivate
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace screen shots and claim form
Replace claim and rescan, update answer key
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
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Comments
Replace screen shots and claim form
Replace claim and rescan, update answer key
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace screen shots
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.Replace claim form
Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
Replace screen shots
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scanned into image, and answer keys revised.
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Claim forms and answer keys need revised,
scanned into image, and answer keys revised.
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with ICD10.
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with ICD10.
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ICD-10 Impact Analysis - EISM Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
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
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
ECM eClient Training: Lesson 3: Searching
Documents N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
ECM eClient Training Lesson 4: Routing
Documents N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
ECM eClient Training Lesson 5: Viewing
Documents N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
ECM eClient Training Lesson 6: Storing and
Editing Documents N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
ECM eClient Training Lesson 7: Course Materials
and Evaluation N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
SSD Work from Home Program: ECM Image
Explorer N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
SSD Work from Home Program: ECM Image
Explorer User Guide
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
Enterprise Data Warehouse FundamentalsN/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
Introduction to DatabasesN/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
Enterprise Data WarehouseN/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
TeradataN/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
SQL Basics IN/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
SQL Basics IIN/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
ITG50374 EDW Fundamentals
SSD2196WBT01 Blue Health Intelligence
ITG20400 ECM eClient
SSD2961 ECM Image Explorer
247507926.xlsx.ms_office - EISM
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ICD-10 Impact Analysis - EISM Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level Comments
SSD2196WBT01 Blue Health Intelligence SQL Basics IIIN/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
SQL Basics IVN/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
EDW Fundamentals AssessmentN/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
SSDxxxxManaged Metadata Environment
N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
EISM1000WBT01Introduction to EISM Division
N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
EISM1000WBT02Introduction to EISM Processes
N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
EISM1000WBT03Records Management Policy
N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
EISM1000WBT04Overview of EISM Systems
N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
EISM2000ETL Mainframe Basics
N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
EISM2001Zena Overview & Best Practices
N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
EISM2002Unix
N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
EISMxxxxApplication Development Fundamentals
N/A
Confirmed with ID, that ANSI5010 changes will
not affect this lesson.
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 Aid
ILT = Instructor Led Training
FG = Facilitator Guide
PG = Participant Guide
Upcoming EISM Courses
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ICD-10 Impact Analysis - SSD Technical Support Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level Comments
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
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ICD-10 Impact Analysis - SSD Technical Support Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level Comments
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
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 Inquiry
M = 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 = Conceptual
SSDXXXX: Pricing
SSD2031-2035: COB
SSDXXXX: COB Overview
SSDXXXX: Introduction to CDHP
SSDXXXX: CDHP
SSDXXXX: Introduction to Blue Transfer
SSDXXXX: Blue Transfer
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ICD-10 Impact Analysis - SSD Technical Support Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level Comments
SSD1536: The Blue Chip Experience Overview J = Job Aid
ILT = Instructor Led Training
FG = Facilitator Guide
PG = Participant Guide
247507926.xlsx.ms_office - SSD Tech
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ICD-10 Impact Analysis - Inquiry CA Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level Comments
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
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ICD-10 Impact Analysis - Inquiry CA Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level Comments
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
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ICD-10 Impact Analysis - Inquiry CA Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level Comments
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
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ICD-10 Impact Analysis - Inquiry CA Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level Comments
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
Live Call Observation Act No No N/A
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
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ICD-10 Impact Analysis - Inquiry CA Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level Comments
SSD1224 IMNU Path 1 and 11: Claim Inquiry
IMNU Path 1 Overview C No No N/A
IMNU Path 11 Overview C No No N/A
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
IMNU Path 12 Overview 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
IMNU Path 13 Overview C 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
Live Call Observation Act No No N/A
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
IMNU Path 15 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
247507926.xlsx.ms_office - Inquiry-CA
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ICD-10 Impact Analysis - Inquiry CA Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level Comments
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
Live Call Observation Act No No N/A
**Working with IMNU Path 1 S CALLS No No N/A
Working with IMNU Path 3 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
Live Call Observation Act No No N/A
Researching COB Payments in IMNU S CALLS No No N/A
Working with IMNU Path 11: Patient
ResponsibilityS CALLS No No N/A
247507926.xlsx.ms_office - Inquiry-CA
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ICD-10 Impact Analysis - Inquiry CA Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level Comments
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
247507926.xlsx.ms_office - Inquiry-CA
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ICD-10 Impact Analysis - Inquiry CA Curriculum
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level Comments
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
Live Call Observation Act No No N/A
**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
Live Call Observation Act No No N/A
Working with IMNU Path 15 S CALLS No No N/A
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
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Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level Comments
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 Inquiry
M = 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 = Conceptual
J = Job Aid
ILT = Instructor Led Training
FG = Facilitator Guide
PG = Participant Guide
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Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
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Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
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Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
Practice Activity: Working with IMNU Path 12 NA
IMNU Path 13 Overview C Yes NA
Practice Activity: Working with IMNU Path 13 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
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Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
Practice Activity: Working with IMNU Path 15 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
Practice Activity: Working with IMNU Path 9 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
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Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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
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
834 Enrollment/ 820 Premium Bill NA = Not Applicable PF = Process Flow
835 Remittance HO = Handout
837 Claims/ NCPDP D.O. C = Conceptual
J = Job Aid
ILT = Instructor Led Training
FG = Facilitator Guide
PG = Participant Guide
Handouts Section
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Comments
shared with Member CA
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
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Comments
SSD1400 The Road to Concierge Customer Service
shared with Member CA
shared with Member CA
shared with Member CA
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
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Comments
SSD1400 The Road to Concierge Customer Service
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
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 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
SSD1400 The Road to Concierge Customer Service
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
Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
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>>
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Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
<<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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Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
<<SSD2081 - Introduction to Examiner>>
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
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 Inquiry
M = 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 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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Course Code Course Name Impacted Lesson Name Impacted Type BlueSource
Impacted
Forms Impacted Impact Level
<<SSD2081 - Introduction to Examiner>> ILT = Instructor Led TrainingFG = Facilitator GuidePG = Participant Guide
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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 ImpactNo ImpactNo Impact
No Impact
No Impact
No ImpactNo ImpactNo ImpactNo ImpactNo ImpactNo ImpactNo Impact
No Impact
No Impact
<<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
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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)
No ImpactNo ImpactNo Impact
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
No ImpactNo ImpactNo Impact
<<SSD2031 COB Introduction and COB Rules>>
<<SSD2084 Durable Medical Equipment (DME)>>
<<SSD2085 Preexisting Condition (PEC)>>
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Comments
<<SSD2081 - Introduction to Examiner>>
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 ImpactNo ImpactNo Impact
No ImpactNo ImpactNo Impact
No ImpactNo ImpactNo 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>>
247507926.xlsx.ms_office - Examiner
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ICD-10 Impact Analysis - Examiner Curriculum
Comments
<<SSD2081 - Introduction to Examiner>>
247507926.xlsx.ms_office - Examiner
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