Knowledge Test

   Among the options below, what do you call the place of service where patients are admitted for more than 24 hours in the hospital?

• A.     Skilled Nursing Facility

• B.  Outpatient

• C.  Inpatient

• D.    Inpatient

    Ambulatory Surgical Center

  What would you quote if deductible is non-embedded, out of pocket is embedded and plan has 1 active member?

• A.     Individual deductible and Family out of pocket

• B.  Family deductible and family out of pocket

• C.     Individual deductible and out of pocket

• D.     Family deductible and out of pocket

1.      What kind of visit limit it is where they have a fix number of visit?

• A.     Hard Max

• B.     Soft Max

1.      If authorization is required for a certain code, do we need to check pre-determination?

• A.     Yes

• B.     No

• C. It depends

1.      Choose all items that apply. What are your probing questions for checking authorization on file?

• A.     Authorization Number

• B.     Member ID

• C.     Date of Service

• D.     CPT Codes

1.      For all levels of care, what are the 3 facilities that we should quote for the benefits?

• A.     Skilled Nursing Facility, Private Duty, Residential Treatment Centers

• B.     Intensive Outpatient Therapy, Physical Therapy Centers, Partial Hospitalization Center

• C. Residential Treatment Center, Partial Hospitalization, Intensive Outpatient Therapy

1.      What kind of claim denial is where member was not an active member when service was rendered?

• A.     RADTJO

• B.     Duplicate Claims

• C. R01030

• D. RDUPN0

1.      What kind of denial is this if this is the action code R21410?

• A.     Corrected Claims

• B. Timely Filling Limit

• C. Medical Records

• D. IHealth/Cotiviti

1.      If they send a corrected claim, what indicator should you see in PICA for CMS 1500 claims?

• A.     PICA 8

• B. PICA 9

• C. PICA 1

• D. PICA 7

For claims that are getting denied for RDELEP, what field/box in the claim forms do you need to check to know the error?

• A. Box 1 and Box 15

• B. Box 32 and Box 33

• C. Box 12 and Box 33

• D. Box 7 and Box 32