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Center for Curriculum and Transfer Articulation
Federal Employee Program Systems: Advanced Procedures
Course: CSR116

First Term: 2020 Summer
 Lec + Lab   4.0 Credit(s)   6.0 Period(s)   6.0 Load  
Subject Type: Occupational
Load Formula: T- Lab Load


Description: Advanced policies and procedures for completing claims. Covers access and navigation of the membership system to include claims processing, pricing, recalculations, and suspends. Also includes anesthesia pricing procedures, deferrals, and J codes.



MCCCD Official Course Competencies
1. Access and navigate membership system. (I)
2. Differentiate between various claim forms. (I)
3. Identify coding schemes. (I)
4. Review guidelines for coding and pricing of claims. (I, II)
5. Compare and contrast pricing fee schedules. (II)
6. Recalculate claim allowances and payments. (II)
7. Define terms related to anesthesia pricing. (II)
8. Complete anesthesia pricing procedures. (II)
9. Compare and contrast claim suspend resolutions. (II, IV)
10. Identify key elements of a claim pertaining to deferrals. (III)
11. Describe coding guidelines with regard to deferrals. (III)
12. Interpret validity and compatibility of various claim components. (III)
13. Complete claim deferral resolutions. (III)
14. Differentiate between cases and claim versions. (IV)
15. Compare and contrast claim versions. (IV)
16. Complete case level actions. (IV)
17. Complete claim suspend resolutions. (IV)
MCCCD Official Course Competencies must be coordinated with the content outline so that each major point in the outline serves one or more competencies. MCCCD faculty retains authority in determining the pedagogical approach, methodology, content sequencing, and assessment metrics for student work. Please see individual course syllabi for additional information, including specific course requirements.
 
MCCCD Official Course Outline
I. Metavance membership system
   A. System
   B. Procedures
   C. Claims
      1. Types
      2. Forms
      3. Use
      4. Procedures
      5. Guidelines
   D. Coding
      1. Schemes
      2. Access
      3. Guidelines
II. Advanced procedures
   A. Pricing
      1. Fee schedule
      2. Guidelines
      3. Forms
      4. Recalculations
   B. Recoveries
      1. Criteria
      2. Action
      3. Templates
   C. Anesthesia
      1. Formulas
      2. Modifiers
      3. Time units
      4. Suspends
      5. Resolution
      6. Guidelines
      7. Pricing
III. Deferrals
   A. Input process
      1. Validity
      2. Translation
      3. Compatibility
   B. Purpose
   C. Billing
   D. Coding
   E. Resolutions
      1. Types
      2. Procedures
IV. J codes
   A. Definition
   B. Use
   C. Claim versions
      1. Original
      2. Internal claim
      3. Corrected claim
      4. Paid
      5. Recovery
   D. Cases
      1. Key points
      2. Searches
      3. Actions
   E. Procedures
 
MCCCD Governing Board Approval Date: May 5, 2020

All information published is subject to change without notice. Every effort has been made to ensure the accuracy of information presented, but based on the dynamic nature of the curricular process, course and program information is subject to change in order to reflect the most current information available.