Claim Edit Checks are ______ and Claim Edit Rules are ______.

Study for the RHB330 Resolute Hospital Billing Claim and Remittance Test with questions, hints, and explanations. Enhance your billing skills and excel in your exam!

Multiple Choice

Claim Edit Checks are ______ and Claim Edit Rules are ______.

In this system, the surface-level validations you can add or customize are handled as Extensions (LPPs), which are the Claim Edit Checks. The actual criteria that determine when an edit fires are encoded as Claim Edit Rules (CERs). So, Claim Edit Checks are Extensions (LPPs) and Claim Edit Rules are CERs. This separation lets you extend validation capabilities through plug-in extensions while keeping the rule logic centralized in CERs. For example, you might add a new check as an extension to catch a payer-specific requirement, while the condition and action that define that edit live in a CER.

In this system, the surface-level validations you can add or customize are handled as Extensions (LPPs), which are the Claim Edit Checks. The actual criteria that determine when an edit fires are encoded as Claim Edit Rules (CERs). So, Claim Edit Checks are Extensions (LPPs) and Claim Edit Rules are CERs. This separation lets you extend validation capabilities through plug-in extensions while keeping the rule logic centralized in CERs. For example, you might add a new check as an extension to catch a payer-specific requirement, while the condition and action that define that edit live in a CER.

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