Final Exam 1
Final Exam 2
Final Exam 3
Final Exam 4
Final Exam 5
100
I am the system you can use to look up physical status modifiers such as P1, P2, P3 or P6.
What is KL (knowledge library)?
100
The two fields in iset where you would find that a claim payment was made electronically.
What are Payment Type and Payee: Payment Method.
100
One of the systems you could use to find DME denial code 5019 means CBA rental/purchase item not covered.
What is COSMOS or Durable Medical Equipment (DME) Competitive Bidding Area (CBA) SOP?
100
Film #OEB24619218 is a reconsideration request submitted by a provider. In what system would I look up this Film # to find the reason the provider submitted this reconsideration?
What is IDRS?
100
I am the system that you would use to access notification details for a claim in 2012.
What is ICUE?
200
Which of the following are most helpful when pulling up a claim? (Select all that apply) Charged amount, Date of service, Date received, Patient name, Type of submission (paper or electronic)
What is Charged amount, Date of service, Patient name?
200
The three dollar amounts that make up the allowed amount
What are the Amount paid, Co-insurance/copayment and Deductible?
200
This is the SOP where you would find the steps to follow when requesting a copy of a Provider Remittance Advice (PRA) when the provider does not want/can not use the online self-serve option.
What is Claims Status and Research One Source under Request Copy of Provider Remittance Advice UnitedHealthcare Medicare & Retirement
200
The system to search when you have a claim number and division from iset.
What is CPW?
200
The three systems that you can use to find deductible and out-of-pocket information.
What are COSMOS, IBAAG & ISET?
300
4 key pieces of information that are needed to track a check a provider has sent in using the TRACR system?
What are Check number, Total dollar amount, Date the check was sent, Date the check was cashed?
300
Place of service 21 is__________
What is Inpatient Hospital?
300
The PET line (resource line) and Escalation calls/Sup calls SOP will advise you to have ready which six pieces of information about yourself/the issue.
What is employee id, sup name, your name, site location, brief description of issue, and the provider's tin?
300
I am the box number(s) on a UB04 where you would find the dx codes.
What are boxes #66, 69 & 70?
300
Using NGT which of the following codes need prior notification 74174 74177 72199 74181 78608 76376
What are 74174, 74177, 74181, 78608, 76376?
400
Which of the following can the provider do on Unitedhealthcareonline.com -Access patient eleigiblity infomation -Bill a patient directly -Request a claim be reconsidered -Status a claim -Submit a claim -Submit a notifiaction
What is Access patient eligiblity information, Request a claim be reconsidered, Status a claim, Submit a claim, Submit a notification?
400
The three components that make up the FLN number are ___________
What are the first 2 = year claim rec'd, 3-5 = julian date claim is rec'd, 6-10 = sequential number assigned for claims rec'd on any given day?
400
I am the SOP where you go to determine which insurance is primary, secondary and if necessary, tertiary. For example, if I have group coverage through my former employer bc I'm now disabled and retired, a Medicare Advantage plan and Medicaid.
What is Determining COB decision tree?
400
For Member ID 802071022 DOS: 04/05/2012 this is the Allowed amount.
What is $66.98
400
What system houses and tracks accumulations of limited services?
What is COSMOS? screen CL147
500
Which CPT code range represents surgical codes? 00100-00199 10040-69999 70100-79999 80002-89399
What is 10040-69999?
500
Which of the following information can be taken over the phone for a claim? (Select all that apply) Date of Service, HCPC code, Patient address, physician address, semi-private room rate
What is Date of service, HCPC code, Semi-private room rate?
500
Which SOP will give you the steps in the most effective workflow order when researching a claim in ISET?
What is The Claim Status and Research OneSource SOP?
500
The system you would use to see if member has LIS.
What is GPS?
500
Name two of the groups that are excluded from radiology prior authorization.
What are Erickson advantage plans, Montefiore Group 66074, United healthcare chronic complete, United healthcare duel complete, United healthcare nursing home plan?
M
e
n
u