WorksheetsFinal Assessment Review
Total questions: 9
Worksheet time: 5mins
Traveling outside of the country claims involves which of these entities?
Blue Cross Alabama
Blue Card/Global Core
Utilization Management
DMHC
For Out of Network providers what is the standard procedure?
Member Pays provider then member submits claim
Provider pays member and makes member submit claim
Member doesn't pay provider, Provider submits claim
Member expects services for free
Which of these is a common rejection reason for the R00000 action code?
Claim has been deleted
Claim is paid
Amount of claim has been reduced
Claim is still pending
If there is a mistake made on the claim who corrects that mistake and resubmits?
Anthem
CIW
Customer Service Rep
Provider
If a claim was rejected for not a covered benefit, which of the following would be the correct actions to take?
Check the benefit to confirm they have it or not
Call the provider
Check to make sure the provider is in network
Nothing
A claim denied for RDUP means
Claim denied for Coordination of benefits
Claim denied as Duplicate
Claim paid
Claim adjusted
Which Coordination of benefits primacy rule applies to children when they are on both of their parents plans and there is no court decree?
Active Longer
Blue on Blue
Birthday Rule
Subscriber Rule
How are members notified on the outcome of their appeal?
Letter
Text
Fax
Where can you see descriptions of procedure codes in SC?
Links--Plan to Plan Information
Links--Look Up Code
Links-- Medical Policy
Links--Phone numbers
