WorksheetsJust Benefits
Total questions: 29
Worksheet time: 15mins
There are two kinds of procedure codes. These are...
HCPCS
ICD-10
CPT
NDC
It is still necessary to ask for the IVR Disclaimer when checking Benefits
True
False
What is a Fee Schedule?
This is a set date and time for the said medical procedure
This is the set date and time for medical fees to be collected
This is the specific price of a medical procedure
This is a specific price of a medical prescription
I provide medical care.
People need to ask for permission before going to someone else
I only go to those I am connected to.
Who am I?
HMO
PPO
EPO
POS
FFS
It doesn't matter whether I'm friends with your friends.
You don't have to ask permission if you're going somewhere
Who am I?
EPO
HMO
PPO
POS
FFS
This pertains to whether a provider or facility is contracted with the medical plan.
Particpation Status
Valid and Billable
Copay
Deductible
I need to see your efforts first before I start taking care of you. Who am I?
Deductible
Copay
Coinsurance
Out of Pocket
Just shoulder our pamasahe. I'll take care of the rest.
Who am I?
deductible
copay
coinsurance
out of pocket max
I can sometimes be strict. I can sometimes be loose.
It all depends how you want to help you.
Who am I?
HMO
EPO
PPO
POS
FFS
I don't just go and be with anyone. I am exclusive to a specific circle only.
Who am I?
HMO
PPO
EPO
POS
FFS
I asked my caller if Eligibility needs to be quoted, and said yes.
I should...
Provide the information as requested
Focus on the main concern only
This pertains to the location where the service will be rendered
Date of Service
Setting (IP/OP)
Place of Service
Billing as Professional/Facility
This pertains to the setting, whether the patient will be admitted or not.
Date of Service
Place of Service
Setting (IP/OP)
Billing as Professional/Facility
I have a problem seeing $1408.35 in the Accumulators. Without zooming in, I should...
Round off to its nearest approximate amount
Have someone else read for me
Read the amount per digit
Checking if Anthem is Primary is still necessary when quoting benefits...
True
False
Frue
Tralse
I should still check for Participating Status if the caller says they are In Network...
Always
If your provider says so, then the provider says so.
Be in doubt. Check
I'll fully take care of you as soon as I'm done receiving all your efforts. Who am I?
Deductible
Copay
Coinsurance
OOP Max
I know you're saving money, so I'll split the bill with you. Who am I?
Deductible
Copay
Coinsurance
OOP Max
I'm too old to care who you are, or your circle of friends. But I'll take care of you just the same. Who am I?
HMO
PPO
POS
EPO
FFS
If I don't have a specific date of service, I should
Pick a random date
Ask if it's okay if today's date is okay
Checking for the status of Authorization is one of our tasks in Provider Services
True
False
When can we use Find Care?
If ASPEN could not determine participating status
If ASPEN says Out of Network
If the Provider is located outside the 14 Anthem states
I can use Anthem anytime.
If ASPEN is not working, I can use this to check Authorization Status
FOBS
EOC
Member 360
CA Mainframe
The name the caller mentioned is Joe West
The name on the system says Juan Kanluran.
I should...
Not proceed with the call
Ask for alternate ID questions
Ask for the name showing on the ID card
I am identifying a caller who claims to be an Anthem Representative. I should...
Ask for his Full Name
Ask for his DOB
Ask for his US Domain and check in our systems
Ask for his HCID
if the COB status says research, I should tell my caller...
that Anthem is Primary
that Anthem is Secondary
that Medicare is Primary
That we have no information on Anthem's COB
If Medicare status if "G", it means
Medicare is Primary, and Anthem is Secondary
Anthem is Primary, and Medicare is Secondary
That we do not know if Medicare is Primary or Secondary
That we do not know if Anthem is Primary or Secondary
Checking for Eligibility, I should provide the X Date
Current
Original
What Probing Questions can I use for PT/OT/ST
is this habilitative/rehabilitative?
is this associated with MH/SA?
is this for purchase rental or repair
is this a consultation, or a regular office visit?
