Claims Overview week one CI&W

 If you identify there has been fraud or PHI has been breached what should you do? choose all options below that apply

• inform OE/Manager

• Report to compliance

• Do nothing

• file a fraud report

What Anthem products will you encounter ( choose all that apply

• PPO

• CDHP

• HMO

• EPO

• POS-Tier Plans

What options below are considered Cost Shares? Choose all that applies

• Deductibles

• Copay

• Co-insurance

• OOP/Stop loss

• Benefit year

In CI&W dashboard you will be able to access your worklist( claims that have been assigned for you to work on)

• False

• True

True or False, The system then routes the claim to a queue for processing based on claim data and group/contract information. If a claim is error free, it is adjudicated by the WGS system without human intervention, while others require manual processing

• True

• False

which claim type below is a professional Claim?

• IA

• PO

• PA

• MA

What are the three parts to a Queue?

• DX code

• Unit Code

• Function Code

• Claim Code

• Statues code

True or false, When your manager assigns work, you may be assigned multiple queues (Ex prompt pay claims, urgent claims ex..). You will be responsible for managing the inventory in the assigned queues/worklist.

• False

• True

You can find the services that a provider is billing for on claim lines?

• True

• False

in what area in CI&W can you find if provider is in network (choose all that applies)

• Provider information field

• Member information field

• Claim header

• Provider POP up