Provider 1

What is a deductible?

• A provision by which the member is responsible for paying a minimal dollar amount at the time a service is rendered.

• The amount of covered expenses for medical treatment that must be incurred and paid by the insured before benefits become payable by the insurer.

• The maximum in benefit dollars paid by the insurer for certain services or conditions during the calendar or benefit year (may be a dollar amount, a number

  of visits amount, or unlimited).

What does HIPAA stand for?

• Health Insurance Portability and Accountability Act

• Health Insurance Privacy and Administration Act

• Health Industry Privacy and Accountability Act

What is PHI?

• Protected health information or PHI refers to individually identifiable health information transmitted or maintained in any form.

• Provider health information or PHI refers to individually identifiable

  provider information transmitted or maintained in any form or medium

  by a HIPAA covered entity.

• Protected health insurance or PHI refers to individually identifiable provider information transmitted or maintained in a specific form or medium by a HIPAA covered entity.

What is a co-pay?

• The maximum in benefit dollars paid by the insurer for certain services or

  conditions during the calendar or benefit year (may be a dollar amount, a number

  of visits amount, or unlimited).

• A provision by which the member is responsible for paying a minimal dollar

  amount at the time a service is rendered.

• The amount of covered expenses for medical treatment that must be incurred

  and paid by the insured before benefits become payable by the insurer.

What type of Informational Alerts displays special handling messages for

litigation decisions, executive priority review or regulatory information?

• CA DMHC

• LERD

• VIP Alerts

Which Composite tab can you view Open Service Requests?

• Member

• Interactions

• Verification History

• Messaging

• Policy & Group

Which Composite tab would you access to view the Grandfathered

information on the member's policy?

• Policy & Group

• Verification History

• Provider

• Member

How do you look-up ICD-1 0 Diagnosis (DX) or Procedure (PCS) codes in ASPEN?

• Select Lookup Code from the Provider menu.

• Select Lookup Code from the Links menu.

• Select Lookup Code from the Search menu.

HIPAA Call Scenario - Mary is calling from a doctor's office and would like to check the status of one of their patient's claims. Based on this scenario, what are the required pieces of information? Choose all that apply

• Patient's ID Number

• Provider's Identification Number

• Patient's DOB

• Name of Provider or Group Practice Name

Can you discuss a member's pre-certification with either a contracting or non-contracting provider if the member is the patient?

• Yes, full disclosure

• No

• Yes, but with limitations