
Appeal Process Flashcard
Flashcard
•
English
•
12th Grade
•
Practice Problem
•
Hard
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15 questions
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1.
FLASHCARD QUESTION
Front
What is the purpose of obtaining HIPAA verification during a verbal DOR process?
Back
To ensure compliance with privacy regulations and protect patient information.
2.
FLASHCARD QUESTION
Front
What can happen if an appeal is submitted without the required form or if the verbal DOR process is not properly documented?
Back
The appeal may be closed.
3.
FLASHCARD QUESTION
Front
What does 'Pre-Service' refer to in the context of healthcare services?
Back
It refers to the service type before the member had the service.
4.
FLASHCARD QUESTION
Front
If a member's claim is denied as not medically necessary, what type of request is this considered?
Back
An Appeal.
5.
FLASHCARD QUESTION
Front
What is a Clinical appeal?
Back
It involves a denial where clinical review was involved.
6.
FLASHCARD QUESTION
Front
What is the significance of the verbal DOR process in the appeal process?
Back
It is a necessary step to document the appeal and ensure all required information is collected.
7.
FLASHCARD QUESTION
Front
What does DOR stand for in the context of appeals?
Back
DOR stands for 'Denial of Request'.
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