Chapter I: Online System Terminology

  Processing Drivers and System Claim Paths

Purpose

Claims that are filed through the FISS DDE Provider Online System follow a prescribed route referred to as a system claim path. Claim paths are constructed of processing drivers, and all claims submitted through the system will encounter these drivers. The claim path notifies the system which processing functions should be executed for each type of bill submitted. 

The processing drivers are the buckets that the claim falls into as it progresses through the system. Each bucket houses all the edits for that particular driver. For example, all of the medical review edits are contained within the medical policy driver (50). 

The following chart outlines all drivers housed within FISS.

As a claim clears the edits contained within each driver, the bucket is then emptied into the next appropriate one for the particular type of bill. This process continues until the claim makes it all the way through the system (i.e., through every driver). If a claim is suspended due to an error, once the error has been resolved the claim begins processing through the claim path back at the beginning. The claim then reprocesses through each of the drivers again, with the exception of the medical policy driver.

While claim paths are very similar for all claims, they do differ slightly depending on the type of bill submitted.

Revised 4/15/2018