
MMAI M7L2L3
Authored by Cynthia Hassett
Other
Professional Development
Used 2+ times

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8 questions
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1.
MULTIPLE CHOICE QUESTION
30 sec • 1 pt
What is the definition of a "medical claim"?
A request for payment for benefits, services, or items rendered by a healthcare provider or supplier
A request to review a processed claim to ensure it was paid properly
A place where medical gold can be mined
A claim that can be processed without obtaining additional information from the provider
2.
MULTIPLE SELECT QUESTION
45 sec • 1 pt
What are two ways a provider can submit a claim?
Electronically
Carrier Pigeon
Paper Form
3.
MULTIPLE CHOICE QUESTION
30 sec • 1 pt
When a baby is born to a mother who is using IL MMAI, the baby is automatically covered.
True
False
4.
MULTIPLE CHOICE QUESTION
30 sec • 1 pt
The Disallowed Amount shown on the claim information in TMGCall reflects which amount?
The Allowed amount plus the Copay
The Billed (charged) amount minus the Allowed amount
The Copay minus the total patient responsibility
The amount paid by the plan
5.
MULTIPLE CHOICE QUESTION
30 sec • 1 pt
A provider may bill the member for the amount the Plan doesn't pay.
True
False
6.
MULTIPLE CHOICE QUESTION
30 sec • 1 pt
The Allowed amount shown on the Claim information in TMGCall reflects:
The amount the provider considers the Market value of the services
The amount the member owes
The contracted amount for the billed services
The amount the IRS expects the provider to bill
7.
MULTIPLE CHOICE QUESTION
30 sec • 1 pt
The Patient responsibility for an MMAI member is likely to be:
Allowed amt minus the Copay
The Copay minus the Allowed amount
The Deductible plus the Copay plus the Coinsurance
Paid at the doctor's office
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