WorksheetsPre-Correspondence Celebration Review
Total questions: 20
Worksheet time: 30mins
What system would you use to view a pre-authorization?
CSA
Streamline
Utility
M360
What system do you use to send out EOBs?
Utility
B Session
FEP Direct
Streamline
Which system do you use to view a remit?
OnDemand/WEBI
FEP Direct
B Session
FEP Recovery Application
Whose allowed amount do we use when we are secondary to Medicare?
The Provider's
The Formula
Medicare's
FEP's
Which disposition represents the most recently updated claim?
1
201
2
203
If a facility bills with a type code of 111, then the service was _____
Skilled Nursing
Observation
Outpatient
Inpatient
Remark code 306 means _____
COB Survey needs to be completed
Non-Covered Service
MEOB is Needed
Primary EOB is Needed
DEFER means that the claim is _____
Approved
Paid
Denied
Still Processing
How long do we tell members/providers to allow for a claim to process?
14 Business Days
7 Business Days
30 Business Days
7 - 10 Business Days
If a provider has not responded to a refund request, that could result in a
NEGATIVE Remit
PENDED Claim
Fine
Denied Claim
Facilities that meet strict measures of qualities are designated as ___________
Blue Distinction Centers
Blue Hospitality Centers
Preferred Facilities
Member Facilities
Which represents the fixed amount of money that is collected by the provider at the time of service?
Coinsurance
Deductible
Copayment
Catastrophic Protection
Our retail pharmacy vendor is ________________
CVS Caremark
Walgreens
Medco
Express Scripts
If a Standard option member sees a PPO dentist, would would they pay for covered services?
The difference between the fee schedule amount and maximum allowable charge (MAC)
$30 copayment
All Charges
The negotiated rate between the patient and the provider
If a New York member goes to a hospital in Ohio, which plan would be responsible for processing the claim?
New York
Georgia
Ohio
New York and Ohio would split the claim
What happens to the deductible if FEP is secondary to Medicare?
Deductible is waived for each member with Medicare A and B primary
Only the policyholder's deductible is waived
The deductible is not impacted
The deductible is reduced
If Medicare denies charges for a member, what will FEP pay?
FEP pays nothing if Medicare denies
100% of covered charges with a copy of denial from Medicare
115% of covered charges with a copy of denial from medicare
50% of covered charge
Which is considered a HIPAA level of authorization?
Authorized
Preferred
Non-Preferred
Automatic
Which type of representative can complete an address change for a member?
Any Representative
Personal Representative
Informal Representative
Authorized Representative
If a member goes to the hospital for surgery, who will bill the member?
Both the hospital and the surgeon
Only the hospital
Only the surgeon
Neither the hospital nor the surgeon
