Chapter 12 HBI 113

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Chapter 12_MC : March 21

employer group health plan

When a patient is covered by a government health program (e.g., Medicare) and an employer group health plan, which is considered primary?

Documentation is submitted to the commercial health insurance plan proving that the other liable party has denied the claim

Under what circumstance will the patient's commercial health insurance plan pay a claim when Block 10 indicates another payer may be primary?

supplemental

Deductibles, copayments, and coinsurance expenses are usually covered by what type of plan?

nursing facility

Which item would have a 2 digit place of service code for use in Block 24B on the CMS-1500?

a. Clinical Laboratory Improvement Amendments (CLIA) number
b. referral number
c. mammography pre-certification number
d. prior authorization number

Information assigned by the payer and tracked in Block 23 includes ____________.

a. the services provided were related to an on-the-job injury.
b. workers' compensation should pay for services reported on the claim.

When a patient's condition is related to work (box 10a),

ust one plan

When the patient is covered by _____, there can never be a secondary payer.

who has a birthday that occurs first in the year.

The "birthday rule" applies when dependent children living at home are covered by more than one health insurance policy. The primary policy is determined by the parent

Last name - First name - Middle initial (separated with commas)

When filling out the CMS-1500 claim form, the policyholder's name should appear as

liability insurance

Insurance that covers losses to a third party caused by the insured, by an object owned by the insured, or on premises owned by the insured is known as

...

When the same payer issues the primary, secondary, or supplemental policies, the correct procedure for submitting the claim would be

...

When a signed ___ and ___ form have been placed in a patient's financial and medical file, SOF may be entered in Blocks 12 and 13 of the CMS-1500.

...

When entering Signature on File in Block 12, the appropriate date to enter would be

...

Which of the following is considered a commercial health insurance company?

...

The shaded area in each line is used to

...

If the patient is an unmarried domestic partner, what is entered in Block 6?

...

If the patient received inpatient services and has not been discharged at the time the claim is completed, the appropriate action (Block 18) would be to

...

When a patient is listed as a dependent on her spouse's employer group health plan (EGHP) and is covered by an EGHP of her own, the spouse's plan is considered

...

CMS-1500 claim form (Block 24) is limited to reporting how many services?

...

Payment for medical treatment of an injury will be denied by the liability payer if

...

Entering Signature on File in Block 12 of the CMS-1500 claim means

...

The format of the patient's birth date should appear on the CMS-1500 claim as

...

If a patient is covered by two different policies, the correct procedure for submitting the paper claim would be

...

In Block 33 of the CMS-1500 claim, the correct way to enter the provider's zip code is

...

What should be entered in Block 11a, if the policyholder's gender is unknown?

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