FACETS claims review WarmUp Quizziz

WHAT SHOWS YOU THE MEMBERS TOTAL RESPONSIBLITIES while in the claims inquiry screen?

• Claim Responsibility Indicator

• Transfer

• Claims Inquiry Tab

• Remittance Tab

This is the only state that will add the newborn to the policy for 60 days. However you still have 31 days to request the newborn be added permanently.

• IN

• OH

• WI

• WY

What tab would you find the received date of a claim?

• Line Item Details

• Status

• Remittance

• Claim Information

What is NOT one of the reasons a claim will deny?

• Needing COB Information

• Eligiblity Reasons

• Address Location

• Non Covered Services

• Investigational/ experimental

What tab do you go to find the check status?

• Status

• Remittance

• Line Item Details

• Claim Information

A claim can only be filed electronically.

• True

• False

Under what tab will you find if a provider was processed as INN from the claim?

• Line Totals

• Line Item Details

• COB

• Notes

What are the 5 W's of researching a claim?(Hint: The same as a complete benefit)

• How, What, When, Where, Why

• Who, What's, When, Where's, Why

• Whom, What, When, Where, Why

• Who, What, When, Where, Why

What is the system you would use if you wanted to view a medical claim document?

• WFC

• KFC

• WCF

• FCF

Adam Jones visits his physician Dr Smith for his annual preventive exam at the Dr's office. After Dr Smith performs the exam, Adam mentions he has a lesion on his back. Dr Smith removes the lesion from Adam's back. A few weeks later, Adam receives a bill from Dr Smiths office for $400. Adam calls Anthem to see why he was billed so much for a preventive office visit. The doctor submitted two procedure codes, one was for a preventive visit. That service was paid at 100%. The second procedure code was for the removal of the lesion. A diagnostic code was used for this one, so that line processed per the member's surgical benefits. The CSR decides to submit the claim for adjustment. Is this the correct action to take?

• Yes. It needed to be adjusted

• No. The claim processed correctly

• Yes. The member needs to call the provider

• No. The member needs to call the provider