during break i need to ________ my computer. when i leave for the day I should ________ my compuer.
Lock
Restart
100
to be covered under this plan is mass this member must see a BCBS MA par provider
blue choice 1 pcp plan aprroved
100
using id # 984508220 member want to change her obgyn to JOn Durfee MD , Boston Ma 02118. She has already had an exam this year how is she covered?
PCP Plan Approved
100
using ID # 983795452 please advise what benefit serive a) allergy testing b) IUD c) crutuches
A) $20 per visit (medical outpatient)
b) no cost (family planning)
c) 20% coinsurance (durable medical equipment)
100
What is the the important questions to ask when getting a claim call?
when was the date of service?
who did you see on that date?
How much is the bill for?
Who was the patient?
200
What are the four group type we can take?
GOV't
Local
EL
Nasco
200
product code for blue choice 1
800
200
using id #984508220 wants to see dr phil mcgraw md for family counseling at his private office in dallas tx how is he covered?
hes covered because he can see any liscenced provider
200
What HMO poduct do we not take?
HMO Blue Options
200
using id#982490051 what is the members diagnosis and the total BCBS allowed 3.15.13?
general medical routine and $185.04
300
What is Rachel's favorite movies?
Triple Jeopardy
The last dragon
eternal sunshine of the spotless mind
300
Doctor Harry Potter of Framingham contracted for blue choice 1
Yes
300
using id #984508220 broke his leg in Colorado sking is going to aspen urgent care, is he covered?
yes PCP Plan aprroved urgent care.
300
which of the following statements is not true about access blue plans?
a) member must select a PCP to get benefits
b) member must stay in HMO blue network
c) members do not need referrals to see netword specialists.
A
300
Name the 5 areas that dont process claims as international
Guam
Jamaica
Northern Marianna Islands
Puerto Rico
The Virgin Islands
400
Explain to Rachel what a deductible
Rachel do they get the 400??
400
why was claim #24130230450700 applied towards this members self referred benefits?
no referral on file
400
using id #984508220 throws out shoulder playing catch with his son. Wants to see John Andrews MD in Atlanta GA. He he covered?
Not covered, balance billing
400
While on a cruise I had to go see a doctor,am I covered, and what do I have to do?
You are covered and will be reimbursed by submitting a subscriber claim, with a form of itemized receipt.
400
using id #9832013857989 recieved a bill $65.74 when I payed a $15 copay why am I recieving this bill. The appointment was in 2013
she went to a doctor and the 15 dollars was towards her deductible not her copay, and she went out of network
500
List 10 common abbreviations we will use on the floor?
SUB
MBR
?
ADV
BENS
DEP
CLD
PV
TOS
OLB
500
using id number 98339367 daughter kendell goes to get her routine exam today. Harrlet dann at norwood eye care. how is she covered?
not covered exam had an exam in the last 2 years.
500
using id # 984112472 the claim for 5.22.13 left the customer for a bill of 147.61 why?
line 1.1 and line 2 service had no referral
then applied to self referred benefit, had a deductible and coinsurance was applied.
500
Eric Cole is calling about a prescripton please advice him
Daily Double....
RxEdo 888-Try REDO
500
*Double Jeopardy* Describe a day in the life of a claim
In Order
1) claim comes in
2) claim is filed
3) claim is entered into flexible data entry
4) patient eligibility is verified
5) claim the process to pricing file
6) moves to benefit verification
7)go through medical policy
8) reviewed for cob
9) proceeds to review
10) check generation adn EOB for provide and subscriber