Claims Claims & More Claims

The Home Plan Determines the allowed amount, Sends EOBS to the Providers and Files claims electronically

• False

• True

This type of code provides additional information about the medical procedure, service, or supply involved without changing the meaning of the code

• Revenue

• Procedure

• Diagnosis

• Modifier

This type of message does not require a response

• Info Message

• General Inq Message

This Type of Code is used to document procedures performed in a doctors office

• Diagnosis

• Procedure

• ICD-10

• Revenue

How much of a discount was given to the member

• $0.00

• $51.72

• $42.28

• $94.00

Which of these is NOT a Claim status

• Open

• Rejected

• Closed

• Denied

If your speaking to a provider and they tell you they made a mistake on the claim and used the wrong code, what should you advise the provider to do

• Re-Submit the claim as a corrected claim

• Send the Claim to be adjusted and add the notes from the provider

• have the provider file an appeal

• Set a Promise Action and contact your OE or manager

These Codes are descriptions and dollar amounts charged for hospital services provided to a patient

• Revenue

• Dollar

• Procedure

• ICD-10

What is the member responsible for according to this claim

• $115.00

• $72.71

• $0

• $29.08

When a member does everything they can to go In Network but Labs are sent to an Out Of Network Provider what can we do?

• Nothing, tell the member to talk to the provider

• Send the claim for an AEG adjustment

• Send the claim for a simple adjustment

• Tell the member to file an Appeal