Medical Terminology
Medical Abbreviation
Benefits
Pends
Training
100
"derm/o"
What is "skin"
100
IBS
What is "irritable bowel synndrome"
100
How many level III claims analysts can we have on one team?
What is "As many as meet the criteria". (not limited)
100
when processing a C016 pend and you get a UMO explanation code returned from an AIM auth denial what should you NOT do?
What is "pend QMQS or pend to QMM.
100
What is our "standard timely filing limit" for providers and members?
What is "must be filed within 12 months of date of service".
200
"gluco"
What is "sweet"
200
ADHA
What is "attention deficit hyperactivity disorder"
200
What hospital claims need to be reviewed by QMM?
What is "high dollar (PHS $30k or more, PBS $50K or more) and interim".
200
True or False: 97033 does not require an auth.
What is "False - Per Pam's e-mail, processors will verify whether there is a PA on file and manually deny per KMS if there is not".
200
How do you copy and EDI image?
What is "you put the claim number in the auth field".
300
"dis"
What is "separation, taking apart"
300
GERD
What is "gastroesophageal reflux disorder"
300
Which frequency codes identify a claim as interim?
What is "2,3,4"
300
Under what circumstance would we use the B09 EOB code when processing a cob claim?
What is "if the primary carrier paid in full and their allowable if higher than PHP's allowable".
300
Define the "80 modifier".
What is "Assistant Surgeon" modifier.
400
"Gloss (o)"
What is "pertaining to the tongue"
400
ADL
What is "activities of daily living"
400
Did you do your biometric screening this year?
What is "no - its no longer required".
400
What do you look for on an air ambulance claim?
What is "Prior auth - or pend QMQ2 for review"
400
Define "50 Modifier".
What is "Bilateral Procedure".
500
"AUX"
What is "increase, growth"
500
OM
What is "otitis media" (ear infection)
500
How many alt care visits will your personal benefits cover?
What is "My plan allows 12 visits per calendar year"
500
Always leave this CPT on the 00 segment when splitting claims.
What is "What is 9894x (or chiropractic manipulation)
500
See if you can pick out one of your team members from this photo and name them.
What is "girl on the far right, which is Linda"
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