Pre-Registration Trainees Assessment

1.

2 points

What are you supposed to do for RTE indicates other insurance primary scenario?

Check in response history to find the primary insurance & add the vendor billing indicator if that policy is termed

Check in response history to find the primary insurance & if that insurance has already been added in application, verify eligibility & benefits for that insurance if that policy is active & change the COB order if needed

Check in response history to find the primary insurance & if that insurance has not been already added, verify eligibility & add the insurance if that policy is active & change the COB order if needed

2.

2 points

For which of the below insurance we have payor website access?

United Healthcare

Medicare

Medicaid

Aetna

3.

2 points

Medicare should not be removed if patient has an active medicare replacement policy

True

False

4.

2 points

What will you do if a policy is termed?

Straight away move the account to calling team

Simply remove that policy from coverage info

Update the termination date for the policy and close the account

Update the effective & termination date for the policy and then search for active policy with patient’s name and DOB in website

5.

2 points

Which of the below action is always mandatory to determine the correct plan for all BCBS out-of-state and Anthem BCBS policies?

Check benefits in experian website

Check eligibility in Blue-E website

Identify to which state the alpha prefix belongs to in mypayerdirectory.com

6.

2 points

For which of the below BCBS NC plans, we are supposed to check group number & group name in order to add the correct plan.

BCBS NC Preferred Care Blue Options PPO

BCBS NC Blue Select

BCBS NC Blue Advantage

BCBS NC Blue Care Open Access HMO

7.

2 points

Identify which of the below option has insurances listed in correct COB order for a patient whose age is 68 & consider medicare got E-Verified

BCBS NC Costwise, Medicare, United Healthcare

Medicare, United Healthcare, Medicaid

Medicare, BCBS, Tricare for life

Medicare, Tricare for Life, GEHA

Medicaid, United Healthcare, Medicare

8.

2 points

Which of the below insurance ID# looks like Medicare ID#?

243765521A

YPPW2315698501

U210526301

80356458901

9.

2 points

If BCBS out-of-state plan belongs to anthem, then what FISC should be added?

BCBS OOS EPO

BCBS OOS POS

BCBS OOS PPO

Anthem BCBS PPO

10.

2 points

If a patient's age is 65 or older, then medicare should always be the _______ payor

11.

2 points

COB order can be determined through experian website

True

False

12.

2 points

Which of the below type of appointments should be loaded with vendor billing indicator?

Appointments with plan mismatch status

Appointments which are moved to calling

Appointments which are moved to needs review status

13.

2 points

If a plan is grayed out, replace it with a new plan, update the effective for the new plan same as the effective date of grayed out plan and then remove the grayed out plan with termination date a day before the effective date of the newly added plan.

True

False

14.

2 points

What would you do for BCBS out-of-state plans & Anthem BCBS PPO Plans which are in content error status & if subscriber ID# is found to be incorrect

Move to calling

Verify eligibility in Blue-E website with three letter alpha prefix followed by patient's SSN to find the correct ID# & still if you are unable to find the correct ID#, then move to calling

Move to needs review status

15.

2 points

Among which of the below insurances, insurance ID# would always ends with 01,02,03,04 and so on. Also relationship to subscriber should always be updated as self.

Cigna and BCBS NC

Medicare and Aetna

United Healthcare

Wellpath/Coventry Healthcare

16.

2 points

Payor address should be updated only if claims address field is empty

True

False

17.

2 points

What is the maximum time limit for deferring an appointment from the date you work on that appointment?

14 Days

5 Days

9 Days

7 Days

18.

2 points

If a patient has his/her own individual ID# that ends with 02/03/04, then what would be the relationship to subscriber?

Self

Unknown

Spouse

Child

19.

2 points

What would you do if a commercial generic plan has no member & subscriber ID#, claims address, phone# & insurance name in it?

Remove that coverage

Move to calling

Move to needs review status

Add generic coverage required billing indicator

20.

2 points

Medicaid & Tricare for Life should always be updated as _________ payor in COB order

First

Second

Least

21.

2 points

What should be updated in group number field for Medicare supplemental plans?

Auth phone#

Subscriber ID#

Plan type like PLAN A,B,C,D...

22.

2 points

No need to add vendor billing indicator if another insurance says Medicare part-A as primary.

True

False

23.

2 points

What date should be updated in verification date in experian website & date of service in payor websites while checking eligibility & benefits?

Current date (Date on which you work)

Appointment date

24.

2 points

Consider appointment date is 08/30/2015 and you are working on that appointment on 08/15/2015. If you are supposed to defer it, then what should be the defer until date?

08/30/2015

08/16/2015

08/22/2015

08/15/2015

25.

2 points

What plan should be added if BCBS response history shows blue options?

BCBS NC Preferred Care Blue Options PPO

BCBC NC Costwise

BCBS NC Blue Advantage EXCH

BCBS NC Blue Care Open Access HMO

26.

2 points

Inside subscriber demographics info, whose SSN, Gender & DOB should be updated?

Subscriber's (Policy holder) information

Always Patient's information even if patient's relationship to subscriber is spouse or child

27.

2 points

What will be your action if a Medicare replacement policy is termed?

Update the termination date for the policy and close the account

Update the termination date for the policy and then check Medicare eligibility to find the current policy

Simply remove that policy from coverage info

Straight away move the account to calling team

28.

2 points

Which of the below type of insurances should not be moved to calling if benefits are not updated after E-Verification & if benefits are not found in experian and payor websites?

UHC Plans

Medicare Supplement Policies like BCBS NC Costwise, AARP Medicare Supplement, AARP Group Hospital Plan, Mutual of Omaha

Medicaid Plans

Cigna Plans

29.

2 points

Coverage claims address should not contain which of the below listed things?

Special characters (, . # / - etc)

Additional spaces

Word “Unknown”

30.

2 points

Whose name should always be updated under payor patient name field?

Subscriber's (Policy holder) name

Patient's name

31.

2 points

For which of the following services facility benefits should be updated?

Primary Care Physician (PCP) office visits

Inpatient hospital admission, emergency room & urgent care services

Physical Therapy (PT) & Occupational Therapy (OT) services

Specialist office visits

32.

2 points

Consider appointment date is 08/25/2015 and you are working on that appointment on 08/22/2015. If you are supposed to defer it, then what should be the defer until date?

08/29/2015

08/22/2015

08/25/2015

08/23/2015

33.

2 points

What is the need for doing eligibility and benefits verification before the date of appointment?

To find out the status (active or termed) of the policy for date of appointment (or) current status

To determine whether a particular service would be covered or not under the patient’s plan

To determine COB information if patient has two or more insurances

34.

2 points

We are not supposed to work on which of the following set of BCBS NC prefixes?

YPZ, YPF, YPX

YPJ, YPL, YPV

YPD, YPH, BDD

YPI, YPW, YPP

35.

2 points

Appointments which are moved to needs review status should be updated with detailed notes in benefits collection, vendor billing indicator & finally defer without fail

True

False

36.

2 points

What plan should be added if UHC response history shows choice and choice plus under plan description?

United Healthcare POS EPO

United Healthcare Choice & United Healthcare Choice Plus

United Healthcare Indemnity

United Healthcare Options PPO

37.

2 points

Medicare & Medicare replacement plans would also cover for dependents (spouse/child) in addition to policy holder (subscriber)

True

False

38.

2 points

Co-insurance will only be given in % whereas co-pay, deductible & out-of-pocket amount would be indicated only in terms of dollars in websites

True

False

39.

2 points

What should you do for Medicare Part-A only coverage?

Verify the coverage and finish the account

Verify the coverage and add Registration opt out of HAR coverage billing indicator

Remove the coverage and add Registration opt out of HAR coverage billing indicator

Terminate the coverage and add Registration opt out of HAR coverage billing indicator

40.

2 points

Identify which of the below option has insurances listed in correct COB order for a patient whose age is 72 & consider medicare got E-Verified

Medicare, Tricare for Life, Medicaid NC

Medicare, UHC, Tricare for Life, Medicaid NC

Medicaid, Medicare, Tricare for Life

Medicare, UHC, Medicaid NC, Tricare for Life

41.

2 points

If the entire family shares the same unique ID#, then appropriate relationship to subscriber (spouse/child) should be updated

True

False

42.

2 points

What type of appointments should be moved to calling?

Generic plans with either insurance name or phone# or claims address

If benefits are not updated & not found in website except for medicare supplement plans & Medicaid plans

If you are unable to determine to which state the alpha prefix belongs to in mypayerdirectory.com

Insurances that do not have payor website & which are not listed in Experian website

43.

2 points

Consider Medicare replacement policy becomes effective from 01/01/2015. Then what would be the termination date for Medicare?

12/31/2014

Same as effective date of Medicare

01/01/2015

44.

2 points

What is the first & foremost thing you should do before opening an appointment?

Verify the payor name

Verify the patient name

Read the coverage rule

None of the above

45.

2 points

Which benefits should be updated if the patient is spouse/child?

Individual benefits

Family benefits

46.

2 points

“Generic coverage required” billing indicator should be added for which of the below type of appointments

Appointments with inactive coverage

Appointments with no P/F tab

Appointments with generic coverage (commercial generic & Medicare advantage generic plans, only if specific plan is not available or claims address in specific plan is incorrect)

Appointments which are moved to needs review status

47.

2 points

Benefits given under Not Applicable option in experian website indicates that benefits are same for both in and out-of-network providers. So, it should be updated without fail

True

False

48.

2 points

What would you do if you are supposed to move appointments with RTE indicates CVG is not primary, supplement returned, verified by phone, verified by website & verified by fax status to calling

Straight away move the account to calling without changing the status

Change the status to new & then move to calling

49.

2 points

We are supposed to work on which of the following coverage tabs?

P/F tab only

P/F and B/H tab

P/F, Sp Pricing, TPL & W/C tab

P/F, Trans & B/H tab

50.

2 points

What would you do if a commercial generic plan has no claims address, phone# & insurance name. But if it has subscriber ID# which starts with three letter alpha prefix followed by the combination of alphabets & numbers

Move the account to needs review status

Straight away move the account to calling

Check eligibility with BCBS & if eligible add under corresponding BCBS plan

Check eligibility with BCBS & move to calling if you are unable to find eligibility with that subscriber ID#