Description
Certification Name: Certified Health Insurance Claims Associate
Global Occupational Skill Standard – GOSS ID: GOSS/HF/CHICA/V1
Eligibility: Graduation or Equivalent or minimum 2 years of relevant experience (experience-based learners can directly enroll and certify).
Objective: The Certified Health Insurance Claims Associate (CHICA) course aims to develop comprehensive knowledge and practical skills required to accurately process, review, and manage health insurance claims. The course provides in-depth understanding of health insurance principles, policy structures, coding systems, regulatory requirements, and claims adjudication procedures.
Certification: Within 5 days after Completion of Online Assessment.
Get ready to join the Journey to become a GSDCI Certified Professional – International Certification and Assessment Body.
Steps to become a GSDCI Certified Professional:
Step 1: Select your certification you want to pursue.
Step 2: Click on get certified tab, new pop up window will open.
Step 3: Click on pay certification fee, you will be redirected to billing details page.
Step 4: Fill your details and click on pay certification fee, you will be redirected to payment gateway, pay fee by any available options like Card (Debit/Credit), Wallet, Paytm, Net banking, UPI and Google pay.
Step 5: You will get Login Credentials of Online E-Books and Online assessment link on your email id, within 48 hrs of payment.
Step 6: After completion of online assessment, you can download your Certificate Immediately.
Assessment Modules:
Module 1: Foundations of Health Insurance and Healthcare Systems: Overview of healthcare delivery systems, Structure and types of health insurance programs, Key terminology used in health insurance and claims, Roles and responsibilities of a Health Insurance Claims Associate, Policyholder and insurer relationships, Regulatory bodies and industry standards
Module 2: Health Insurance Policies, Coverage, and Benefits: Policy components and contract language, Eligibility determination and verification, Covered vs. non-covered services, Preauthorization and referral requirements, Coordination of benefits and dual coverage rules, Understanding deductibles, copays, and coinsurance
Module 3: Medical Coding and Documentation for Claims Processing: Introduction to ICD-10-CM diagnosis coding, Basics of CPT and HCPCS procedure coding, Use of modifiers in billing, Medical documentation requirements, Linking codes to medical necessity, Identifying common coding and documentation errors
Module 4: Claims Processing and Adjudication Workflow: Types of healthcare claims (professional, institutional, pharmacy), Claim form components (CMS-1500 and UB-04), Electronic claims submission standards, Steps in claim adjudication and payment calculation, Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA), Timely filing limits and correction processes
Module 5: Denials, Appeals, and Claims Resolution: Common claim denials and their root causes, Denial management strategies, Writing effective appeal letters, Reconsideration and dispute resolution processes, Audits and claim review procedures, Communication with providers and policyholders
Module 6: Compliance, Ethics, and Regulatory Requirements in Claims Handling: HIPAA privacy and security regulations, Fraud, waste, and abuse prevention, CMS, NAIC, and state regulatory guidelines, Ethical standards in claims decision-making, Data accuracy and record retention requirements, Continuous learning and professional conduct
GSDCI Online Assessment Detail:
- Duration- 60 minutes.
- Number of Questions- 30.
- Number of Questions from each module: 5.
- Language: English.
- Exam Type: Multiple Choice Questions.
- Maximum Marks- 100, Passing Marks- 50%.
- There is no negative marking in any module.
| Marking System: | |||
| S.No. | No. of Questions | Marks Each Question | Total Marks |
| 1 | 10 | 5 | 50 |
| 2 | 5 | 4 | 20 |
| 3 | 5 | 3 | 15 |
| 4 | 5 | 2 | 10 |
| 5 | 5 | 1 | 5 |
| 30 | 100 | ||
| How Students will be Graded: | |||
| S.No. | Marks | Grade | |
| 1 | 91-100 | O (Outstanding) | |
| 2 | 81-90 | A+ (Excellent) | |
| 3 | 71-80 | A (Very Good) | |
| 4 | 61-70 | B (Good) | |
| 5 | 50-60 | P (Pass) | |
| 6 | 0-49 | F (Fail) | |
Benefits of Certification:
🌍 1. Global Recognition & Credibility – Stand out worldwide with a certification that opens doors across borders. Trusted by employers, respected by institutions, and recognized in over 100 countries.
📜 2. Quality Assurance through ISO Certification – Certified to global ISO standards, our programs deliver excellence, consistency, and a benchmarked learning experience that speaks for itself.
💼 3. Career Advancement & Employability – Enhances your resume and increases chances of promotions or job offers.
🤝 4. Non-Profit Trust Factor – Certifications from non-profit organizations are mission-driven rather than profit-driven.
📚 5. Access to Verified Learning & Resources – Often includes e-books, mock tests, and online support without hidden costs.
🔍 6. Transparency & Online Verification – Certifications come with a unique Enrolment ID for easy online verification by employers and institutions.
⏳ 7. Lifetime or Long-Term Validity – Certifications usually have lifetime validity or long-term recognition, reducing the need for frequent renewals.
