WorksheetsFACETS claims review WarmUp Quizziz
Total questions: 12
Worksheet time: 8mins
WHAT SHOWS YOU THE MEMBERS TOTAL RESPONSIBLITIES while in the claims inquiry screen?
Claim Responsibility Indicator
Transfer
Claims Inquiry Tab
Remittance Tab
This is the only state that will add the newborn to the policy for 60 days. However you still have 31 days to request the newborn be added permanently.
IN
OH
WI
WY
What tab would you find the received date of a claim?
Line Item Details
Status
Remittance
Claim Information
What is NOT one of the reasons a claim will deny?
Needing COB Information
Eligiblity Reasons
Address Location
Non Covered Services
Investigational/ experimental
What tab do you go to find the check status?
Status
Remittance
Line Item Details
Claim Information
A claim can only be filed electronically.
True
False
Under what tab will you find if a provider was processed as INN from the claim?
Line Totals
Line Item Details
COB
Notes
What are the 5 W's of researching a claim?(Hint: The same as a complete benefit)
How, What, When, Where, Why
Who, What's, When, Where's, Why
Whom, What, When, Where, Why
Who, What, When, Where, Why
What is the system you would use if you wanted to view a medical claim document?
WFC
KFC
WCF
FCF
Adam Jones visits his physician Dr Smith for his annual preventive exam at the Dr's office. After Dr Smith performs the exam, Adam mentions he has a lesion on his back. Dr Smith removes the lesion from Adam's back. A few weeks later, Adam receives a bill from Dr Smiths office for $400. Adam calls Anthem to see why he was billed so much for a preventive office visit. The doctor submitted two procedure codes, one was for a preventive visit. That service was paid at 100%. The second procedure code was for the removal of the lesion. A diagnostic code was used for this one, so that line processed per the member's surgical benefits. The CSR decides to submit the claim for adjustment. Is this the correct action to take?
Yes. It needed to be adjusted
No. The claim processed correctly
Yes. The member needs to call the provider
No. The member needs to call the provider
How do you bring the claims inquiry screen up from the customer service screen?
Transfer>Member accums
Transfer> Claims Inquiry> Open Customer/Medical
Transfer> Claims Inquiry> Open Customer/Vision
Transfer> Claims Inquiry> Open Customer/Dental
This would be a reason to use WCF?
To view the carbon copy of the claim
To Verify a members address
To view members benefits
To view the members social media accounts
