HIPAA needs to be validated before disclosing any member specific information
True
False
Medicare part C is for
Only Inpatient services
Only Outpatient services
Medicare Advantage Plans
Prescription Drugs
All inbound and outbound calls need to be documented in Onvida
False
True
CMS stands for
Centers for Medicare and Member Services
Centers for Medicare and Medicaid Services
Calculated Member Services
Customer Member Services
Before disclosing any member specific information, providers need to verify
Member’s name
Member’s ID number
Member’s date of birth
All of the above
We can hang up on the caller if they are being rude
True
False
We can search if a provider is In-network by using Bright Health website
True
False
The one time ‘Welcome to Medicare’ preventive visit can be used
Only once
Once every year
Once a month
Twice a month
All IFP member id calls need to be cold transferred
True
False
All documents received by Bright Health on a member’s account can be checked in
Qnxt
DMS – Document Management System
PaySpan
UPC
Providers can submit claims by
Mail
Fax
Email
Avality
If a member calls to check benefit information it would be
an Inquiry
an Organization Determination
a Grievance
a Complaint
A member calls in to complaint about a doctor (In-network with Bright Health) who was very rude and unprofessional with them. This would be a
Inquiry
Organization Determination
Grievance
None of the options
We can identify the claim type (facility/professional) in claims module through one of the below options
CPT Codes
Diagnosis Codes
Form Types
Claim line item details can be seen in one of the below tabs in claims modules
Services
Pay
Edits
0
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