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WorksheetsKnowledge Test
Total questions: 15
Worksheet time: 8mins
Among the options below, what do you call the place of service where patients are admitted for more than 24 hours in the hospital?
A. Skilled Nursing Facility
B. Outpatient
C. Inpatient
D. Inpatient
Ambulatory Surgical Center
What would you quote if deductible is non-embedded, out of pocket is embedded and plan has 1 active member?
A. Individual deductible and Family out of pocket
B. Family deductible and family out of pocket
C. Individual deductible and out of pocket
D. Family deductible and out of pocket
1. What kind of visit limit it is where they have a fix number of visit?
A. Hard Max
B. Soft Max
1. If authorization is required for a certain code, do we need to check pre-determination?
A. Yes
B. No
C. It depends
1. Choose all items that apply. What are your probing questions for checking authorization on file?
A. Authorization Number
B. Member ID
C. Date of Service
D. CPT Codes
1. For all levels of care, what are the 3 facilities that we should quote for the benefits?
A. Skilled Nursing Facility, Private Duty, Residential Treatment Centers
B. Intensive Outpatient Therapy, Physical Therapy Centers, Partial Hospitalization Center
C. Residential Treatment Center, Partial Hospitalization, Intensive Outpatient Therapy
1. What kind of claim denial is where member was not an active member when service was rendered?
A. RADTJO
B. Duplicate Claims
C. R01030
D. RDUPN0
1. What kind of denial is this if this is the action code R21410?
A. Corrected Claims
B. Timely Filling Limit
C. Medical Records
D. IHealth/Cotiviti
1. If they send a corrected claim, what indicator should you see in PICA for CMS 1500 claims?
A. PICA 8
B. PICA 9
C. PICA 1
D. PICA 7
For claims that are getting denied for RDELEP, what field/box in the claim forms do you need to check to know the error?
A. Box 1 and Box 15
B. Box 32 and Box 33
C. Box 12 and Box 33
D. Box 7 and Box 32
1. If line status code is “D”, what does this mean?
A. Code is denied for ihealth/cotiviti
B. Code is denied for Claimxten
C. Code is denied for Medical Policy
D. Code is denied for Eligibility
1. What is the TAT for claims to process?
A. 30-35 Business Days
B. 20-35 Calendar Days
C. 30-45 Business Days
D. 7-15 Business Days
13. What does EOB stand for?
A. Explanation of Benefits
B. Explanation of Bereavement
C. Explanation of Bonds
D. Explanation of Betterment
If the reason of the denial is CXT Rule 15, where do you get the claimxten ID?
A. Processing Details
B. Claims Bundling Information
C. Claims Bundling Destination
D. Claims Bundling Details
15. If we can locate the authorization on file in manage authorization, what tool do we use for this?
A. Membership Form
B. Member 360
C. Claims Inquiry Tool
D. Claims WCF
