Duke PB Followup

1.

1 point

What is deferral guidelines for Medicaid newly submitted claim?

60

20

45

35

2.

1 point

While working on invoice if the claim denied for MR and found DEPs has no records. What action will you take?

Need to transfer the claim to coding team

Transfer to supervisor

Work according to the job aid received on DEPs without records in MC.

None of the above

3.

1 point

What is corrected claim filing limit for Cigna?

90

120

180

None of the above

4.

1 point

Medicare Part C processed claim and paid / patient responsibility. When Medicaid denied the claim with MA04 along with 01704 or 01703 (RECIPIENT ELIGIBILITY INDICATES MEDICARE PART C / NO PART C PRESENT). What action will you take?

Defer for 30 days

Do not touch those invoice

Transfer to Reg WQ

We need to call Medicaid and verify what coverage / Plan they have on file for part C

5.

1 point

We need to select frequency code 7 when we are filing a corrected claim to medicare

True

False

6.

1 point

When you find a dummy claim with a PRV modifier what action will you take?

Resubmit the claim

Move the claim to coding

Move to WQ 16997

Adjust the charges

7.

1 point

If invoice denied for past timely manner and we submitted claim after the timely filing limit of which the billed amount of the claim is $1000.00 how is the adjustment taken?

Through maestro care

Through Hyland adjustment form

Escalate to supervisor

None of the above

8.

1 point

There is new column added to your Wqs – Account Type. This will indicate if the guarantor account is Personal/Family, BH or WC?

True

False

9.

1 point

Medicare Ophthalmology invoices with 52 modifier defer for 30 days.

True

False

10.

1 point

When a CPT 90460 is billed with a Office Visit Code and the claim is denied by Medicaid what action should be taken.

Adjust the charges

Bill Patient

Move the claim to Coding WQ to check for the coding issue

Resubmit the claim

11.

1 point

Can we consider ERA 835 shows as 22 cob denial for cardinal Innovations?

True

False

12.

1 point

Medicaid Pregnant women plan is effective as of

03/01/2016

01/01/2016

01/01/2015

02/01/2016

13.

1 point

What is the deferral guidelines for Medicaid LME (Recently billed claims)?

30

60

75

20

14.

1 point

Medicare denied the claim as “N324-N324 INCMPL/INV LAST SEEN/VISIT DATE”. What is the next step of action?

Move the claim to coding

Defer the claim for 30 days

Escalate the issue to supervisor

None of the above

15.

1 point

We can take adjustment under 3049 pay code for corrected claims

True

False

Duke PB Followup_Sep-16