Week 5
Claims Processing Knowledge Quiz
Test your knowledge on claims processing with our engaging quiz designed to challenge your understanding of important concepts and procedures.
- 5 multiple-choice questions
- Topics covering claims, enrollment, and benefits
- Score your knowledge and learn from your mistakes
When the members authorized person calls with a question on a claim, the CSA telephone source is M.
True
False
A claim is billed with POS 81, an out of area location in Box 32 and a NY location in Box 33. Your only provider legacy number doesn’t match NY, it matches the out of area location. What is the correct action:
Send the claim to the lead queue?
Process the claim with IB02 on the lines?
Send the claim to Med Review?
Deny the claim T597/T474?
A member calls and advises they found a check we issued to them in 2016, their bank will not honor the check and the member is asking us to reissue a new check to them. Which of the following would you advise the member?
1. Yes, you can have a new check reissued to them and to allow 30 days to receive.
2. Take the check back to their bank advising them to honor it as our checks have no expiration date
3. Advise the member we have a five-year limitation of the re-issuance of uncashed checks
4. Send to the lead for a manual check to be issued to the member
When a member calls regarding their enrollment ie if dependent is on the plan that should not be or a dependent should be On the contract and is missing from the contract, what is your first point of contact?
Ask your Co Worker
Ask your Manager
Call Enrollment 202-488-4200 Option 1 to inquire about the contract
No action required, the problem will work itself out.
The Basic Option Member with Medicare A & B Primary asks about the Skilled Nursing benefit. What do you advise?
There are no benefits for admission to an extended care or skilled nursing facility
Benefits are available for the following covered services when provided as outpatient services and billed by a Preferred skilled nursing facility.
FEP Case Management assists Members with complex health care needs; however, speaking to a Case Manager does not guarantee additional benefits. I have provided the benefits according to your contract. May I connect you with FEP Case Management?
All of the above.
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