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Medicare Reimbursement UniversityProfessional Medicare DMEPOS billing education by Medicare Reimbursement Navigator

Medicare Reimbursement University

Claims Transactions and Adjudication

Study eligibility, payer order, CMS-1500 and 837P relationships, acknowledgments, adjudication, 835 remittance, corrections, reopenings, appeals, and filing controls.

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Difficulty

intermediate

Estimated duration

7h

Modules

8

Published lessons

8

Course progress0%

Target audience

New and experienced DME billing, supplier, clinic, and healthcare revenue-cycle staff.

Learning outcomes

  • Apply a source-linked workflow for claim data foundations.
  • Apply a source-linked workflow for eligibility and payer order.
  • Apply a source-linked workflow for professional claim and 837p.
  • Apply a source-linked workflow for front-end acknowledgments.
  • Apply a source-linked workflow for adjudication and remittance.
  • Apply a source-linked workflow for corrections and reopenings.

Modules and lessons

Module 01Claim Data FoundationsTranslate supported source facts into controlled claim data.
From Medical Record to Claim Data45 minOpen module overview
Module 02Eligibility and Payer OrderEstablish coverage, benefits, payer order, and authorization facts.
Eligibility, Benefits, and Payer Order45 minOpen module overview
Module 03Professional Claim and 837PConnect CMS-1500 concepts to the electronic 837P transaction.
CMS-1500 and 837P for Supplier Claims45 minOpen module overview
Module 04Front-End AcknowledgmentsReconcile transmission, acceptance, rejection, and payer receipt.
Submission, Acknowledgments, and Rejections45 minOpen module overview
Module 05Adjudication and RemittanceInterpret adjudication and the 835 remittance record.
Adjudication and the 835 ERA45 minOpen module overview
Module 06Corrections and ReopeningsChoose correction, replacement, or reopening based on claim status.
Correction, Replacement, Reopening, or Appeal45 minOpen module overview
Module 07Appeals and DeadlinesControl filing and appeal deadlines using the governing notice.
Filing and Appeal Deadline Controls45 minOpen module overview
Module 08Claim Lifecycle LabApply the complete claim lifecycle to a de-identified case.
End-to-End Claim Lifecycle Lab45 minOpen module overview

Knowledge checks

Claims Transactions and Adjudication AssessmentPassing score: 80%

Enrollment and completion

Enrollment stores private progress in your existing account. Public lesson reading remains available without enrollment.

A private educational completion certificate may be issued after verified course completion. This is not an official Medicare certification program.