Pre-Registration Client Specific Test February 2015

1.

10 points

Name given in the bottom of the name list is the subscriber’s name in UMR & Tricare payor websites

True

False

2.

10 points

What should be done if insurance indicated in a coverage RTE is termed?

Move to calling

Move to needs review status

Add vendor billing indicator with appropriate notes

3.

10 points

What should you do for hospital accounts that open with new patient wizard?

Add vendor billing indicator

Do not work on those kind of accounts

Defer the account with appropriate notes

4.

10 points

What should be done after verifying commercial generic & medicare advantage generic plans if specific FISC is not available?

Add generic coverage required billing indicator

Move to needs review status

Add vendor billing indicator

Move to calling

5.

10 points

What should you do for hospital accounts that do not have insurance coverage?

Create hospital account and add generic coverage required billing indicator

Create hospital account, update notes in benefit collection and add vendor billing indicator

Create hospital account, update notes in benefit collection and defer the appointment

6.

10 points

What should be your action for appointments with medicare part-A only coverage?

Just remove medicare part-A & add registration opt out of HAR coverage billing indicator

Add vendor billing indicator

Term medicare part-A & add registration opt out of HAR coverage billing indicator

Move to needs review status

7.

10 points

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

Update the termination date for the policy and close the account

Simply remove that policy from coverage info

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

Straight away move the account to calling team

8.

10 points

What FISC should be added if utilization management shows as Anthem Blue Cross and Blue Shield in Experian website for BCBS out of state plans?

Commercial generic plan

BCBS NC Preferred Care Blue Options PPO

Anthem Health Plans

BCBS out of state plan

9.

10 points

YPY alpha prefix should be loaded under which of the following FISC

BCBS NC Blue Advantage

NC State Employee PPO Smart Choice Basic Plus

BCBS NC Blue Select Tiered PPO

BCBS NC Preferred Care Blue Options PPO

10.

10 points

What would you do if B/H or transplant insurance is added under P/F tab?

Move to calling

Remove that B/H or transplant insurance

Move to needs review status, add vendor billing indicator & defer

Do not work on those kind of accounts