Worksheets8.22 Test 1 Prep Quiz
Total questions: 20
Worksheet time: 10mins
On Question 1, is this policy self-funded or fully insured?
Self-Funded
Fully Insured
On Question 2, is this policy self-funded or fully insured?
Self-Funded
Fully Insured
On Question 3, is this policy self-funded or fully insured?
Self-Funded
Fully Insured
On Question 4a, how much has Erin met towards her 2022 INN deductible?
$2,000.00
$2,163.00
$1,551.80
$1,439.95
On Question 4b, how much did the first claim that processed towards her 2022 INN deductible apply to her 2022 INN deductible?
$448.20
$1,439.95
$134.95
$1,305.00
On Question 4c, what is the claim number of the claim that last applied to her 2022 INN deductible?
EXTF1YF9PK00
EXTD6ZR5KD00
EXTD7HK6QZ01
EXTF3GY7PR00
On Question 4d, open the claim from the last answer. What is this claim for?
Ultrasound
X-Ray
Covid Test
Preventive Exam
On Question 4e, who is the provider on the above claim?
Howard E. Herrell
Amber N. Mullins
Christina M. Oskins
Derek C. Welch
On Question 4f, how much does the member owe on the above claim?
$165.64
$252.00
$163.00
$118.37
On Question 5, what information is found in Block 27 of the CMS-1500 claim form?
NPI
Subscriber ID
Patient Account Number
Accept Assignment
On Question 6, what information is found in Block 17b of the CMS-1500 claim form?
Revenue Codes
Occurrence Codes
NPI
Principal Diagnosis Code
On Question 7 what information is found in Block 42 of the CMS-1450 claim form?
Other Insurance
Revenue Codes
Occurrence Codes
Value Codes
On Question 8, what information is found in Block 17 of the CMS-1450 claim form?
Status
NPI
Accept Assignment
Unit Number
On Question 9, per MPM, quantitative sensory testing is considered what?
medically necessary
medically appropriate
cosmetic
investigational
On Question 10, per MPM, which conditions/diseases are considered investigational for hippotherapy? (CHOOSE ALL THAT APPLY)
Down syndrone
Learning of language disabilities
Developmental delay
Parkinson's disease
On Question 11, per MPM, rhinoplasty for the purpose of correcting a nasal deformity due to a previous cosmetic surgery is considered what?
cosmetic
medically appropriate
investigational
medically necessary
On Question 12a, member needs to have a diabetic retinopathy screening with an INN optometrist, what is his benefit?
100% of maximum allowable charge
100% of maximum allowable charge, 1 per benefit period
not covered
$1400.00 and then 70% of maximum allowable charge
On Question 12b, member needs to have a sleep study done at an OON office, what is his benefit?
$3000 deductible and then 70% of maximum allowable charge
70% of maximum allowable charge
$3000 deductible and then 50% of maximum allowable charge subject to balance billing
$3000 deductible and then 70% of maximum allowable charge subject to balance billing
On Question 13a, why was the claim denied?
PSS Exceeds the Scheduled Rate
XCD Other insurance info requested
z27 Diagnosis Not Typical For Age
PSV Exceeds the RVU x CVF Rate
On Question 13b, what did the member owe on the adjusted claim?
$7.00
$11.00
$18.00
$0.00
