Claims Assessment

When will we consider a claim stale/late?

• After a year from the date of service

• After 4 months from service Date

• After 3 months from the service date

• After 2 months from the service date

Claims may only be submitted via email, post and fax

• True

• False

What is a procedure code?

• This is an item code used for the practice records only

• 4 - 6 digit number that advises what treatment was provided to the member

• Procedure codes do not exist in the Medical Industry

Which of the below options can cause a claim to pay directly to a member?

• Proof of payment is indicated

• Optometrist Claim

• Provider is charging above the DHR

• The doctor has elected to be paid directly by Discovery

A claim is paid to the member and then reversed by the practice. What will the financial impact be for the member?

• There will be no impact

• The practice will need to refind the patient

• An amount owing to the Scheme will be created which the member will need to pay back

• The member will need to refund the practice

Which screen is used to view the Claim Payments that can be made to a member?

• Claims Statement Screen

• Consolidated Screen

• Limit Screen

• Claim Query Screen

Only the provider can submit claims to us

• True

• False

Which of the below tells us the dosage, strength and form of the medication a patient has received

• The medication code

• NAPPI code

• Procedure code

• ICD-10 Code

Members can view thier claims on the website, but not the mobile app if the claim is older than 6 months

• True

• False

Which of these is NOT considered valid proof of payment from a member

• A receipt

• Handwriteen wording saying "paid"

• A paid stamp

• An EFT Slip