NJ
List an injury that would qualify as a ‘Catastrophic’ injury based on the policy contract?
What is Permenant or Significant Brain or Spinal Cord Injuries ?
What information is necessary to obtain on an Inbound call to verify a Medical Provider?
What is Callers Name | Name of Provider | FULL Name of IP and one of below: Claim Number, Policy Number, DOL, Last 4 of SSN, DOB
True or False: If there is a CCC listed on a claim, it is our obligation to advise the IP of the coverage issues and state that coverage is under review.
What is TRUE?
If the NI as APIPC1 coverage on their policy, who is allowed to use that additional coverage?
What is Named Insured and any Relatives?
What system do we use to review precertifications?
What is Medflow?
Would an employer be added to a claim as a Related Contact or an Associated Party?
What is related contact?
What steps must be taken to properly resolve a CC99?
What is Confirm payment cleared in EDGE and Confirm DOL with a PR, Tow Bill, ER Records etc?
Which box on the HCFA is the CPT code listed in?
What is Box 24D?
What coverage is afforded to a Stranger who does not have any coverage of their own?
What is PIP E?
Which form allows the medical provider to be paid directly from GEICO for medical treatment provider to the IP? Assignment of Benefits
What is AOB (assignment of benefits)?
List 2 PRU Indicators
What is Commercial Vehicle, MedPay, Manufacturers Defect, Dram?
The precertification process starts _____ days after the Date of Loss
What is 10 days?
What should FPM eligibility and ABP be set to if we are denying a claim?
What is not eligible?
What is the correct order to apply penalties, copayments and deductibles?
What is Co Payment Penalty, Deductible, Co Payment?
On an APIPE Policy, what is the weekly Lost Wage limit?
What is $400 weekly?
The medical provider will have a ___% co payment penalty if they do not follow the precertification process.
What is 50?
List 2 exclusions to the NJ Policy Contract
What is Committing a high misdemeanor or felony, or seeking to avoid lawful apprehension or arrest
Operating an auto without the permission of the owner?
If the NI has a PIP Full PIP Primary policy, what letters should be sent at the opening? NJ
What is NJ Standard Letter and Dear Patient AOB?
List the documents that must be received if an IP is making a claim for essential services for a housekeeper to come to their house
What is Letter of Medical Necessity | Cancelled Check or Money Order | Completed Essential Services Form?
List an ICD-10 code that could be applicable for a Cervical Strain
What is S13.4XXA?
List the 7 Medicare Elements
What is Name, CASS Address, DOB, Gender, SSN, ICD-10, NF Limit?
What does KFI mean? When might we use this functionality?
What is Key From Image- To send bills that were faxed back to MBR?
List the 8 items that must be listed on a proper bill
What is IP Full Name | TIN | Billing Address | POS | Treating Physician Name | DOS | CPT Code | Charge Amount ?
Our GEICO NI is injured while in an Enterprise rental car, who would be primary for the NI PIP? GEICO
What is GEICO?
If a pedestrian is struck by a GEICO insured vehicle, where should the pedestrian first review for coverage? If they do not have that coverage where can they file a claim?
What is their own insurance or HH Insurance | NJ PLGIA?