WorksheetsAnalyst 1
Total questions: 20
Worksheet time: 11mins
Our Mission Statement is
Improving lives through quality of care.
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List the Lines of Business for DHP
STAR, STAR Kids, CHIP Perinate
STAR Plus, CHIP Perinate, STAR Kids
STAR, STAR Kids, CHIP Perinate, CHIP
CHIP Perinate, CHIP, STAR
What does TMHP stand for?
Too Many Health Plans
Training Manual for Health Plan
Texas Medicaid Healthcare Partnership
Texas Medicaid Health Plan
What is UMCM?
Uniform Managed Care Mission
Underwater Mine Counter Measures
United Marine Corps Manual
Uniform Managed Care Manual
What does TMPPM stand for?
(a)
Which of these is a CMS 1500 form?
Hard-copy professional claims, generally submitted by physicians are on which type of form:
UB-04
CMS 1500
HMSA 1500
HMSA 04
Which of the following services would be expected to be reported on a CMS-1500 claim form?
Room and board
Physician office visits and surgical procedures
Inpatient Services
Supplies for local anesthesia
What does it mean for a provider to accept assignment?
To accept the patients assigned to the office as new patients
To accept the negotiated rate as the full rate for the service
To accept payment in full from the patient
To accept responsibility for the assignment of the diagnostic and procedure codes
What information is located in block 21 of the CMS-1500 form?
Diagnosis
CPT Codes
ICD-10-CM
Provider NPI
SOF
What is entered in block 1a. of the CMS-1500 form?
Insured's ID number
Patient name
Patient address
Insured's name
What is entered in block 24D. of the CMS-1500 form?
ICD-10-CM codes
modifiers
CPT/HCPCS codes
federal tax ID number
Which Block would you enter the rendering provider NPI number into on the CMS-1500 form?
31
28
33a
24J
Which Block would you enter the referring provider NPI number into on the CMS-1500 form?
17a
17b
33a
24J
Which Block would you enter the patient name into on the CMS-1500 form?
1a
2
4
5
Which block contains patient DOB on the CMS-1500 form?
2
3
4
5
What is entered in block 24G. of the CMS-1500 form?
ICD-10-CM codes
modifiers
CPT/HCPCS codes
Days/units
What is the place of service (POS) code for the physician's office?
62
11
12
61
What type of services are reported on a UB-04 form?
Physician services
Non-physician practitioner services
Surgeries performed at ambulatory surgical center (ASCs)
Hospital facility services
