BENEFIT Exhuasted

If a service is allowed to pay for $2,000.00 in a year and insurance has already paid the same service for $2,000.00 in a year. So, when the same service is again billed to insurance in the same year, it is denied for the maximum benefit reached. Is the claim denied correctly?

• Yes

• No

If a service is allowed to pay for 10 times in a year and insurance has already paid the same service for 8 times in a year. So, when the same service is again billed to insurance for the 9th time in the same year, it is denied for the maximum benefit reached. Is the claim denied correctly? Yes

• Yes

• No

Tags

CCSS.3.OA.D.9

If you receive the status on call as the claim is denied as the patient has reached the maximum benefit allowed in terms of dollars then what will be your next questions?

• How many Visit is allowed?

• How much visit has patient met excluding this claim?
  

• Both of the above
  

• None of the above
  

If you receive the status on call as the claim is denied as the patient has reached the maximum benefit allowed in terms of dollar or visit and the patient has not met the allowed dollar amount or visit excluding this claim then what will be your next questions?

• Could you please send the claim back for reprocessing since patient has not met the the allowed dollar amount or visit excluding this claim?

• What is the TAT for reprocessing?
  

• May I have the claim# & call ref#?
  

• All of the above
  
  

If the claim is denied as the patient has reached the maximum benefit allowed in terms of dollar and the patient has met the allowed dollar amount excluding this claim and there is no secondary insurance available then what will be your action?

• Resubmit the claim to secondary insurance

• Release the claim to the patient
  

• Set the follow-up for the TAT
  

• None of the above
  
  

If the claim is denied as the patient has reached the maximum benefit allowed in terms of dollars and the patient has not met the allowed dollar amount excluding this claim and sends the claim back for reprocessing then what will be your action?

• Submit the claim to secondary insurance

• Release the claim to the patient
  

• Ask for the TAT while reprocessing
  

• None of the above

If the claim is denied as the patient has reached the maximum benefit allowed in terms of visit and the patient has met the allowed visit excluding this claim and there is secondary insurance available then what will be your action?

• Will submit the claim to secondary insurance even if it is not active on DOS

• Will submit the claim to secondary insurance only if it is active on DOS
  

• Release the claim to the patient
  

What is denial code for Maximum benefit met ?

• CO-29
  

• CO-97
  

• CO-119
  

• CO-29