Claims Flow
start
ESCAPE ROOM
introduction
Prove you’re a whizz and win the stars to show you knowledge you have gained. Complete the missions to win the stars and reach the final prize.
enter
EXIT
Adjudication
Medical Svcs Provided
Explanation & Payments
EXIT
1/5
When a member goes to the doctor and presents their insurance id card, why is this provided at time of service?
to submit a claim
for treatment to be rendered
to provide health history
to provide a diagnosis
EXIT
2/5
What is transcribed on a claim form from the provider visit?
medical records
upcoming follow up appointments
notes, diagnosis and svc rendered
patient history
EXIT
3/5
Forms of claim submission
Mail,fax,EDI and portal
hand to hand submission
by svc center appointment
by phone to svc center
EXIT
Adjudication
Medical Svcs Provided
Explanation and Payments
EXIT
1/5
Which system is responsible for Auto Adjudication?
PowerSTEPP
Family Files
EXIT
2/5
Some claims are able to be adjudicated by the system without manual intervention, while others remain open and must be handled by claim analysts
True
False
EXIT
3/5
Once a check cycle hits, all adjudicated claims move on to ECHO.
False
True
EXIT
Medical Svcs provided
Adjudication
Explanation & Payments
EXIT
1/5
Claim and adjudication details are sent electronically to ECHO, a payment processing vendor.
False
True ✔️
EXIT
2/5
Echo will sort and compile claims to disperse EOB's and EPP's by:
Families✔️
Individuals
EXIT
3/5
ECHO generates provider EPP's and issues payments on which day?
Wednesday✔️
Friday
EXIT
4/5
With payment sent by ECHO, it now falls upon who to reconcile the payment information with the submitted claim?
Luminare Health
Provider Office ✔️
EXIT
5/5
ECHO generates member EOB's when?
Monthly✔️
Weekly
back
CONGRATS!
You've completed all the missions and here's your well deserved trophy You've got rhythm in your veins!
Are you SURE you want to LEAVE?
yes
no
YOU FAILED, TRY AGAIN
back
Claims Flow
Regan
Created on November 5, 2025
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Transcript
Claims Flow
start
ESCAPE ROOM
introduction
Prove you’re a whizz and win the stars to show you knowledge you have gained. Complete the missions to win the stars and reach the final prize.
enter
EXIT
Adjudication
Medical Svcs Provided
Explanation & Payments
EXIT
1/5
When a member goes to the doctor and presents their insurance id card, why is this provided at time of service?
to submit a claim
for treatment to be rendered
to provide health history
to provide a diagnosis
EXIT
2/5
What is transcribed on a claim form from the provider visit?
medical records
upcoming follow up appointments
notes, diagnosis and svc rendered
patient history
EXIT
3/5
Forms of claim submission
Mail,fax,EDI and portal
hand to hand submission
by svc center appointment
by phone to svc center
EXIT
Adjudication
Medical Svcs Provided
Explanation and Payments
EXIT
1/5
Which system is responsible for Auto Adjudication?
PowerSTEPP
Family Files
EXIT
2/5
Some claims are able to be adjudicated by the system without manual intervention, while others remain open and must be handled by claim analysts
True
False
EXIT
3/5
Once a check cycle hits, all adjudicated claims move on to ECHO.
False
True
EXIT
Medical Svcs provided
Adjudication
Explanation & Payments
EXIT
1/5
Claim and adjudication details are sent electronically to ECHO, a payment processing vendor.
False
True ✔️
EXIT
2/5
Echo will sort and compile claims to disperse EOB's and EPP's by:
Families✔️
Individuals
EXIT
3/5
ECHO generates provider EPP's and issues payments on which day?
Wednesday✔️
Friday
EXIT
4/5
With payment sent by ECHO, it now falls upon who to reconcile the payment information with the submitted claim?
Luminare Health
Provider Office ✔️
EXIT
5/5
ECHO generates member EOB's when?
Monthly✔️
Weekly
back
CONGRATS!
You've completed all the missions and here's your well deserved trophy You've got rhythm in your veins!
Are you SURE you want to LEAVE?
yes
no
YOU FAILED, TRY AGAIN
back