Methodology Questionnaire

A professional healthcare provider discussing methodology with a team, in a bright office setting, with charts and documents in the background.

Methodology Mastery Quiz

Test your knowledge on provider methodology in this comprehensive quiz designed for healthcare professionals. This quiz covers essential guidelines and procedures to enhance your understanding and application in real-world scenarios.

10 engaging multiple-choice questions
Instant feedback on your answers
Improve your methodology skills and support your team effectively

10 Questions2 MinutesCreated by OptimizingCare101

1.) When do I give methodology to the provider who called in?

A. All client for providers calling in.

B. To providers on claims for UHC EPDP, Oxford EPDP, Aetna and Cigna SOD.

C. All the above.

2.) After giving methodology to the inbound provider calls for an Aetna claim, if the provider will not accept the DIS Provider Accept amount, I close the provider inquiry as:

A. Inquiry Resolved

B. Maximum Allowed Paid

C. I do not close the provider inquiry after giving the methodology for an Aetna claim.

3.) After giving methodology to the inbound provider call for an Oxford EPDP or UHC EPDP claim, if the provider will not accept the DIS Provider Accept amount, I close the provider inquiry as:

A. Inquiry Resolved

B. Maximum Allowed Paid

C. I auto assign the provider inquiry.

4.)On a provider inbound phone call, after giving the methodology, if the claim is not for Aetna, Oxford EPDP, UHC EPDP, Cigna stand on, I auto assign the Provider Inquiry letting them know you will forward the inquiry for an additional review for an associate to contact them with next available steps?

True

False

5.) When requesting a copy of the balance bill, what queue do you assign member balance bill inquiries to?

A. Auto assign the Member Inquiry

B. Close the Member Inquiry as Internal Resolution

C. Manually assign the Member Inquiry to DID.

D. Manually assign the Member Inquiry to D1D.

If the provider does not sign the Letter of Term, and there is no response from the provider, you auto assign the provider inquiry issue when the claim is not for Aetna, UHC EPDP, Oxford EPDP, or Cigna stand on.

True

False

7.) When a provider is willing to accept the Data iSight allowed amount, after explain and defending the methodology, I do the following steps:

A. Generate a DIS Provider Accept Letter of Term, selecting provider accept DIS original rate option.

B. Verify provider fax # or email address

C. Add provider contact information if not in Toolbox

D. Make sure your name is listed as the “Negotiator” on the open claim.

E. Check status every 2 business days.

F. Close after 3 attempts.

G. None of the above.

H. All of the above.

9.) If the member is on the phone, and I verify it is a PAD letter, I open a Member Inquiry, document the call and close Internal Resolution.

True

False

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