Week 6
Healthcare Claims Quiz
Test your knowledge about healthcare claims processing with this engaging quiz! Designed to challenge your understanding of out-of-network claims, billing issues, and provider communication, this quiz covers critical aspects of the healthcare claims field.
By participating, you will learn:
- The timely filing requirements for out-of-network claims.
- How to verify immunization billing.
- The workflow for determining service bundling.
- Which dental plans apply to specific claims.
- Proper coding for provider pin submissions.
What is the timely filing for an out of network claim to be submitted?
180 days from the date of service
We do not take out of network claims
December 31 of the following year
120 days for the date of service
Which bluelink would you use when a provider advises the immunization billed should have allow multiple administration fees and you want need to verify the number allowable?
1. Professional provider lookup New York
FKB FKF modifiers 51 59 76 91 and 99
Injection and Vaccines
CXT Appeals
The Provider says the service is not bundled. The override field just has an E611 and the place of service is 23. What BLUELINK doc Steps will determine if the service is bundled?
1. Professional Provider Look Up New York
2. ClaimsXten CXT – Claim Lab
3. NYHCRA Price Bundle – NY
4. All of the above
What dental plan do we automatically cross over too when the dental date of service is final?
Aetna
Delta Dental
FEP Blue Dental
All of the above
If a provider submits a claim as an individual provider but the pin starts with a W and it is not a specialty that is shown as and exception in the Professional Provider Look Up -New York BL. Can you code the individual provider to this pin?
Yes, because the providers name is showing as the group
No, because the pin is a group pin not individual
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