WorksheetsCLAIMS WEEK3
Total questions: 30
Worksheet time: 23mins
Name
Class
Date
1.
18 months are allowed to file a claim for the following...Non par providers, State Health Plan members, members and who?
a)
Out of Country Providers
b)
Participating Providers
c)
Out of State Providers
d)
Contracted Providers
2.
What screen in Power MHS should be used to verify enrollment ?
a)
ME1088
b)
ME1083
c)
ME1014
d)
PR1014
3.
What type of medical code is used to report medical, surgical, and diagnostic procedures.
a)
Modifier Codes
b)
Revenue Codes
c)
HCPS Codes
d)
Procedure Codes
4.
How many days does a member have to file an appeal after a claim has completed the adjudication process or has denied.
a)
90 days
b)
180 days
c)
60 days
d)
30 days
5.
A Provider may submit an appeal on a member’s behalf if and only if the following steps are taken ?
a)
the member gives verbal permission
b)
the member gives no permission
c)
the member calls BCBSNC
d)
the member gives written permission
6.
This type of provider has 180 days from the date of service or discharge to file a claim.
a)
Participating NC Provider
b)
Participating ND Provider
c)
Non- Participating Provider
d)
Out of State Provider
7.
Where do you go in Power MHS to research a Mailback?
a)
ME1014
b)
CL1088
c)
RF1031
d)
ED1021
8.
Who is responsible for making sure the Authorization is obtained if the member sees a non- par provider
a)
BCBSNC
b)
Provider
c)
Member
d)
Member and Provider
9.
With Prompt pay BCBSNC has how many calendar days to pay, deny, or request additional information after receipt of a claim
a)
60
b)
90
c)
30
d)
120
10.
The difference between the providers charge and the allowed amount is the ...
a)
Deductible
b)
Liability
c)
Coinsurance
d)
Balance Bill
11.
What would you call a claim that comes with an EOP and has corrections made to the original submission ?
a)
Corrected Claim
b)
Modified Claim
c)
Changed Claim
d)
Normal Claim
12.
The process of determining how much money will be paid for a particular claim is.....
a)
Adjudication
b)
Allowed Amount
c)
Ancillary Services
d)
Ambulance
13.
The first 2 digits in a facets claim number represent the what?
a)
an Original Claim
b)
The year the claim was entered into Facets
c)
Julian Date
d)
Split Claim
14.
Where are paper claims submitted to?
a)
Health Care Management claims address
b)
Health Equity claims address
c)
BCBSNC claims address
d)
Correspondence General address
15.
What are the 2 ways to electronically submit claims?
a)
Mail and Fax
b)
Institutional and Professional
c)
Facets and Service First
d)
Real Med and Blue E
16.
In Facets claims status cannot be provided when the status code is what?
a)
99, 91, 81
b)
01, 02, 03
c)
16, 17, 18
d)
11, 15, 16
17.
What is the description of the hold code DS?
a)
Deny
b)
Service Not authorized
c)
Not medically necessay
d)
Review COB
18.
What type of code will stop a claims payment
a)
Delay Code
b)
Informational Code
c)
Approval Code
d)
Denial Code
19.
This is NOT required from a provider calling about a claim
a)
Claim amount
b)
Date of Service
c)
Caller Name
d)
Address
20.
Service Codes Represent the what on a claim?
a)
Patients condition
b)
Authorization is on file
c)
Service Provided to patient
d)
Price of allowed amount
21.
An Explanation of Benefit will not be generated when....
a)
The member only has a copay
b)
The claim is a subscriber pay claim
c)
The Claim is for an adjustment
d)
When services are out of network
22.
A new claim should be filed when.....
a)
EOP received and corrections required for originally billed charges
b)
EOP received with claim disposition code ECN.
c)
Additional information is requested
d)
anytime BCBSNC request money back
23.
The Shingles Vaccine is a covered benefit and is recommended for members over what age?
a)
45
b)
25
c)
60
d)
50
24.
According to the Service Class Definitions Job aid, which letter will indicate a NON covered service code?
a)
Z
b)
Y
c)
X
d)
W
25.
Care Radius is s system used to verify what type of information ?
a)
I Health Hold Code denials
b)
Authorizations on file
c)
Rx on File
d)
Medical Procedures on File
26.
How many days must pass for finance to consider a stop, pay, and reinsurance of a check ?
a)
15
b)
30
c)
45
d)
60
27.
How will the CSP identify the claim has a change or a denial recommended by the iHealth (CIT) system?
a)
With a 1i hold code
b)
With a 4i hold code
c)
With a 2i hold code
d)
With a 3i hold code
28.
In Service First, we provide claim status when the claim is in a status of what ?
a)
Paid and Ready
b)
Paid and Posted
c)
Paid and Open
d)
Open and Ready
29.
Demographic information can be updated by whom on a medical policy?
a)
Anyone on the policy over 18
b)
Subscriber
c)
Subscriber and spouse
d)
Dependents
30.
Ancillary providers include Specialty Pharmacy, DME suppliers and who
a)
Independent Labs
b)
Medical Labs
c)
Mail Order Pharmacy
d)
Clinical Trials
100 %
