IFM II: Claims Research Practice Using Claims GUI 2

Using Claims GUI, answer the question below for the claim that your trainer provides.

For the original claim, what is the current status of the claim?

• Withdrawn

• Issued - No Payment

• Paid

• Disapproved

Using Claims GUI, answer the question below for the claim that your trainer provides.

What was the BlueCross BlueShield payment, if anything?

• $2494.00

• $2320.00

• $118.84

• 0.00

Using Claims GUI, answer the question below for the claim that your trainer provides. What is the patient responsibility for the original claim?

• 0.00

• $118.84

• $2320.00

• $2494.00

Using Claims GUI, answer the question below for the claim that your trainer provides. What date was payment sent on the original claim?

• 06/19/2024

• 06/27/2024

• 06/28/2024

• 08/07/2024

Using Claims GUI, answer the question below for the claim that your trainer provides.

Were any lines of services denied?

• No, all service were covered

• Yes, service line 1 was denied

• Yes, service line 2 was denied

• The full claim was denied

Using Claims GUI, answer the question below for the claim that your trainer provides. What is the ineligible reason code (IRC) for the original claim, on service line 1?

• 129

• 400

• 360

• 22E

Using Claims GUI, answer the question below for the claim that your trainer provides. Are there any CPT Modifier(s) billed on this claim?

• No

• Yes, 1

• Yes, 2

• Yes, 50

Using Claims GUI, answer the question below for the claim that your trainer provides. Why did BlueCross BlueShield, not cover service line 1?

• On or After termination date

• Service Requires Prior Authorization

• This service is not a Benefit of the contract

• The maximum benefit available for this service has been paid

Where in ACE could you determine if a prior authorization was obtained for the patient?

• Patient Card

• Plan Summary Card

• Claims and Appeal Card

• Pre Service Card

Using Claims GUI, answer the question below for the claim that your trainer provides. What tab can tell you if this claim has been adjusted?

• Overview Tab

• Provider Tab

• Payment Tab

• Claim History Tab

• Service Tab