Good Cause Assessment
Good Cause Assessment Quiz
Test your knowledge and understanding of Good Cause criteria and claims processing with our engaging quiz. Whether you're a professional in the field or just looking to learn more, this quiz offers valuable insights.
- 10 carefully crafted multiple-choice and checkbox questions.
- Assess your understanding of timelines, definitions, and exceptions.
What is the date of denial?
EOB/PRA date describing the reasons for a denied claim
The date UHG receives and Appeal or Grievance.
The date you begin working an appeal in ATS
What is the document that provides direction on determining timely filing?
M&R Compliance Grid
Part C Post Service SOP
Good Cause & Late Filing SOP
Scenario Research Tool
Which of the following are valid good cause rationales
Death in the family
Too busy to get paperwork done
Billy went to see his doctor on May 2, 2022 but his claim denied on May 28, 2022. We received an appeal from Billy on September 9, 2022. Was the appeal received timely?
Yes
No
Which of the following definitions describe Balance Billing?
The member receives a bill from the provider for the charges not paid by the plan
The provider bills the member for their cost share.
The member gets a second notice regarding an unpaid copay.
The member feels they should have no out of pocket costs due to being dual eligible.
You're dismissing a Non Par Provider appeal for lack of Good Cause. Which document is not required to be included on the case?
INIT CORR
PRA
ELIG SCREEN
PROV ELIG STATUS
POE
CLAIM
What are considered to be Good Cause Exceptions?
Balance Billing, Clerical Errors, Fraud Waste Abuse Errors
Balance Billing, Duplicate Claims, Fraud Waste Abuse & Errors
What are the possible outcomes for a Good Cause review?
Dismiss or Accept
Accept or Void
Withdraw, Void, Accept, Dismiss
Non Par Provider submitted an untimely appeal. Review the UID PTPAP-20220822094929455 and determine if there is GC for filing outside the 180 days allowed.
Yes
No
Reference the Good Cause for Late Filing SOP. If a correspondence contains a WOL and is received after a case has dismissed for lack of WOL and Good Cause, what does the SOP direct you to do?
Dismiss for lack of GC
Accept for timely filing
Reclassify case to an Inquiry
Send your case for void
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