NY Final

What three things must you first attempt to verify on each call?

• ID#, Social, Group Name

• Full Name, Date of Birth, ID#

• Full Name, Caller Name, ID#

If the spouse is calling in on their 23 year old child to verify coverage, what option will you choose in the HIPAA tool for who is calling?

• Parent/Legal Guardian

• Member

• Informal Representative

• Subscriber

If the spouse is calling in on their 3 year old child to verify coverage, what option will you choose in the HIPAA tool for who is calling?

• Parent/Legal Guardian

• Member

• Informal Representative

• Subscriber

Which of the following systems must you check whenever it is present in the verification process to ensure no passwords are on file or to look for HIPAA authorizations

• Contractor

• Caller Type

• On Demand

• CIRS

Which of the following is NOT a way we can offer to provide the member with their ID card?

• Mail

• Email

• Text

• Fax

• Show them where they can print online

What task will you choose in Solution Central to update a member’s address?

• Group Search

• Consumer Driven Health Plans

• Member Maintenance

• Manage Authorizations

A provider whose contract type does not match the members plan. Example, a HMO member visits a PPO provider

• Allowed Amount

• Balance Billing

• Qualifying Event

• In Network

• Out of Network

The amount Anthem and the provider have negotiated for the services that the provider will render to our members.

• Allowed Amount

• Balance Billing

• Qualifying Event

• In Network

• Out of Network

A life-changing event that allows a member to make changes to their plan. Changes include adding or removing a member from their plan. Examples include marriage, divorce, childbirth and adoption.

• Allowed Amount

• Balance Billing

• Qualifying Event

• In Network

• Out of Network

The additional amount of money a member can be charged when visiting a non-contracted provider. This amount is above the agreed upon amount contracted providers receive for their services.

• Allowed Amount

• Balance Billing

• Qualifying Event

• In Network

• Out of Network