5 Written questions
5 Matching questions
- GENDER RULE
- BIRTHDAY RULE
- PRIMARY INSURANCE
- a THE FATHERS PLAN IS ALWAYS PRIMARY WHEN A CHILD IS COVERED BY BOTH PARENTS
- b PROVIDES CENTRALIZED CLAIMS PROCESSING FOR PROVIDERS AND HEALTH PLAN
- c The guideline that determines which of two parents with medical coverage has the primary insurance for a child; the parent whose day of birth is earlier in the calendar year is considered primary.
- d The health plan that pays benefits first when a patient is covered by more than one plan.
- e PARTICIPATING PROVIDER
5 Multiple choice questions
- PROFESSIONAL SVCS/TECHNICAL SVCS, MODIFIERS ADDED
- Health Insurance Claim Form
- FINANCIAL RECORD FOR INDIVIDUAL PATIENT THAT DAY
- ACCURATE CLAIM FORM
- DOCUMENTED AS A LETTER, SIGNED BY PROVIDER EXPLAINING WHY A CLAIM SHOULD BE RECONSIDRERED
5 True/False questions
ELECTRONIC FLAT FILE FORMAT → EDI - COMPUTER TO COMPUTER EXCHANGE OF DATA BETW. PROVIDER AND PAYER
VALUE ADDED NETWORK (VAN) → the maximum amount the payer will reimburse for ecah procedure or service, according to the paitent's policy.
GUARANTOR → PARTICIPATING PROVIDER
ASSIGNMENT OF BENEFITS → An arrangement by which a patient requests that his or her health insurance benefit payments be made directly to a physician or hospital is called a(n):
PATIENT LEDGER/PATIENT ACCOUNT RECORD → ESTABLISHED PATIENT