Healthcare QNXT
QNXT (Trizetto Claims processing system) provides several functionality which is supported under the application group or you can call modules.It helps the organizations to perform their day to day operational work by utilizing any or all of the application groups. QNXT is a registered trademark of Trizetto. QNXT is a web based system ,developed in .Net technology and all the business rules are running behind the scene as a core functionality.It allows the industry users to be in compliant with all the latest mandates and legislation as long as the latest version of the solution is in place by the Facets users.
Duration: 30hrs
Course Content:
- Introduction of Healthcare
- Building block of Healthcare
- Claims Module
- Definition of Insurance Claim
- Claim generation
- Claims Models Healthcare claims overview – Institutional,Professional, Dental and Pharmacy
- Types of Claims
- Health Insurance claims process – Adjudication (Acceptance, Denials, Rejections, others)
- Claim Submission
- Claims Intake process
- Claims Adjudication
- Claims Payment Header Details Line level Details
- Overview of Benefit
- Benefit Plan Module
- Creating New Benefit
- Adding exclusions
- Adding Service Groups
- Adding EOB/Remit Messages
- Managing Restriction Groups
- Managing Accumulators
- Managing codes(CPT,REV)
- Managing Copay
- Managing Diagnosis codes(ICD- 9,ICD10)
- Definition
- ER Diagram
- Provider Search
- Adding a Provider
- Affiliations- Definition and Types
- Affiliates
- Affiliations Tab overview
- Add an attribute
- Edit and Delete attribute
- Managing Contract affiliations
- Participation status
- Managing Plan affiliations
- Service Groups
- Adding a service group
- Specialty
- Adding a specialty
- Memos and Alert
- Finance
- Member Counts
- Cap Adjustments
