MMAI M7L2L3

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

What are two ways a provider can submit a claim?

• Email

• Electronically

• Carrier Pigeon

• Paper Form

When a baby is born to a mother who is using IL MMAI, the baby is automatically covered.

• True

• False

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

A provider may bill the member for the amount the Plan doesn't pay.

• True

• False

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

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

A claim from a Provider might be denied if (Select all that apply):

• The Provider uses the wrong form

• The Provider turns in the claim too late

• The Provider bills for a non-covered service

• The Provider is a jerk