Final Assessment 3

Front

What is a provider write-off?

Back

A provider write-off is the amount that a healthcare provider agrees to not charge a patient or insurance company, typically due to contractual agreements.

Front

What should you do if a member wants to appeal a denied prior authorization?

Back

You should reverify the member once you have started the Verbal DOR process with the member's full name, date of birth, and address.

Front

What is the purpose of the California State Mandates article?

Back

The California State Mandates article provides information on timely access to care requirements in California.

Front

Can a member receive a physical card if they are signed up for digital cards?

Back

Yes, Member Experience can send physical cards even if the member has enrolled in digital.

Front

How long does Anthem have to resolve an exempt grievance?

Back

Anthem has to resolve an exempt grievance by the end of the next business day.

Front

What is the allowed amount in healthcare billing?

Back

The allowed amount is the maximum amount a health insurance company will pay for a covered service.

Front

What is a deductible in health insurance?

Back

A deductible is the amount a member must pay out-of-pocket for healthcare services before their insurance begins to pay.

Front

What does it mean to verify a member's information?

Back

Verifying a member's information means confirming their identity and eligibility for services using details like name, date of birth, and address.

Front

What is the significance of a balanced billed amount?

Back

The balanced billed amount is the difference between what the provider charges and what the insurance pays, which the patient may be responsible for.

Front

What is the role of Member Experience in healthcare?

Back

Member Experience is responsible for assisting members with their inquiries, including issues related to their insurance cards.