Week 9

You are working a front-end claim hitting FKB. Your code is not billed with Medicare, is not a vaccine admin code or dental code and is billed with a 59 modifier. Do you:

Deny the line TFKE

Combine the line with another billed on the the claim.

Review the FKA BL

Override the line with AFKB

Member calls and questions why they have a ER copay when they went to Urgent Care. What do you do.

Advise the caller no problem I can send the claim back to have the copay corrected

follow the Urgent Care Claims Bluelink and follow the Steps for Phone Inquiries.

Advise the caller the copay is correct and there is nothingyou can do.

None of the above

If you receive a written request from a provider who advises the claim in question processed incorrectly, you have had the claim adjusted and no change in processing has been made. You are working a piece of cora, can you allow the recently adjusted eob to go out as the response to the provider even though there was no change in processing?

True

False

If a Medicare EOB shows ASG N, $Allowed 148.52, $Pd Pov 116.44, $Ded 0.00, $Co-Ins 29.70 what would we use for the Medicare allowed amount?

$146.14

$148.52

$116.44

Blue

Enrollment changes and corrections can be requested for the following reasons:

Requesting a change due to a Qualifying Legal Event (QLE). Examples of this type of event are marriage or divorce.

Requesting a change for legal reasons . An example of this type of event is legal name change.

Requesting a correction of an error that occurred during the enrollment process when the enrollment record was established. Example of this type of correction is a name being misspelled.

All of the above

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