Final Assessment Review

Traveling outside of the country claims involves which of these entities?

• Blue Cross Alabama

• Blue Card/Global Core

• Utilization Management

• DMHC

For Out of Network providers what is the standard procedure?

• Member Pays provider then member submits claim

• Provider pays member and makes member submit claim

• Member doesn't pay provider, Provider submits claim

• Member expects services for free

Which of these is a common rejection reason for the R00000 action code?

• Claim has been deleted

• Claim is paid

• Amount of claim has been reduced

• Claim is still pending

If there is a mistake made on the claim who corrects that mistake and resubmits?

• Anthem

• CIW

• Customer Service Rep

• Provider

If a claim was rejected for not a covered benefit, which of the following would be the correct actions to take?

• Check the benefit to confirm they have it or not

• Call the provider

• Check to make sure the provider is in network

• Nothing

A claim denied for RDUP means

• Claim denied for Coordination of benefits

• Claim denied as Duplicate

• Claim paid

• Claim adjusted

Which Coordination of benefits primacy rule applies to children when they are on both of their parents plans and there is no court decree?

• Active Longer

• Blue on Blue

• Birthday Rule

• Subscriber Rule

How are members notified on the outcome of their appeal?

• Letter

• Text

• Email

• Fax

Where can you see descriptions of procedure codes in SC?

• Links--Plan to Plan Information

• Links--Look Up Code

• Links-- Medical Policy

• Links--Phone numbers