Benefits
Who is the vendor contracted to administer the retail and mail order pharmacy program for FEP ?
CVS/ Caremark
Which resource tool is used to help you determine what type of PHI you can disclose to a caller?
HIPAA Verification and Disclosure Guide
A member has the Basic Option Plan and was sent for a preventive cholesterol test at a Preferred independent lab. What's the appropriate Category and Sub-Category?
Category: Adult Preventive
Sub-Category: Adult Preventive- Professional
How does the Basic Option differ from the Standard Option? The Basic Option doesn’t have ________.
Deductible
Hannah is getting married and her fiancé has two sons under the age of 26 that will live with them full time. When will Vanessa’s fiancé and his sons qualify for coverage?
The fiancé and his children may be added as of the date of the marriage
Which of these requires precertification?
A) Inpatient admission where Medicare Part A is the primary payer of the hospital stay
B) Admission through the outpatient emergency department of a hospital
C) Admission to a hospital outside the US
Admission through the outpatient emergency department of a hospital
What information can you offer to a provider who is unable to validate a member?
Benefit information with no PHI information
A member with Basic Option, has been given a prescription for a CPAP machine. Her doctor recommended a Non-participating provider. What are the appropriate Category and Sub-Category?
Category: DME
Sub-Category: DME
Which of these termination reasons qualify a member for a 31-day grace period?
A) Changing carriers
B) Death
C) Divorce
Divorce
What is the difference between the plan allowance and the billed amount with a Preferred provider?
Provider write-off
What is the fixed dollar amount collected by the provider at the time of service?
Copayment
When does the HIPAA authority for personal representatives typically expire?
With a written request from the member or death of the member
A member experienced a medical emergency and was seen by a non-participating doctor in the emergency room of a Preferred hospital. What are the appropriate Category and Sub-Category?
Category: Medical Emergency
Sub-Category: Emergency Room
If a patient goes to the hospital for outpatient surgery, who will bill the patient?
Both the hospital and surgeon
Eric is a federal employee and covers his wife and two teenage daughters. If one of his daughters becomes pregnant, under which circumstance would anything beyond the birth and routine care of the child be covered?
Situations where the newborn is under guardianship or foster care of the subscriber
What are the member’s out-of-pocket expenses if the member has the Standard Option and visits a Preferred dentist for routine dental care?
The difference between the fee schedule amount and negotiated maximum allowable charge
A member is inquiring about services he’s going to receive from a doctor located in a state we don’t service. What information are you UNABLE to provide to him?
Provider network status
A member with Blue Focus, is having their gallbladder removed. What's the appropriate Category and Sub-Category if they use a Preferred Outpatient Surgery Center?
Category: Outpatient Hospital/ ASC
Sub-Category: Surgical and Treatment Services
If Adamarys terminated her employment with the federal government, how long can she extend her coverage under the Temporary Continuation of Coverage provision?
18 months
David is a federal employee covered under enrollment code 105, and his wife receives health benefits from her full-time employer. Their children are covered under both plans. How do we determine the primary plan for the children?
The parent whose birthday falls first in the calendar year
FEP evaluates healthcare services on a case-by-case basis when deciding on payment. What type of service plan are we considered?
Fee for Service
Joan is an Informal Representative and is calling about a procedure for her mother who is a member. They both live in Indiana, but her mother isn’t present. Joan has information about the procedure such as the claim number, date of service and provider name. What type of authority does Sarah have?
Inferred authority
A member with Standard Option made an appointment for an EKG with his primary care physician, who is a Preferred provider. What's the appropriate Category and Sub-Category?
Category: Testing Professional
Sub-Category: Labs/ EKGs
Which life event is considered a Qualifying Life Event?
A) Self Only Plan subscriber's spouse diagnosed with life threatening illness
B) Subscriber becomes dissatisfied with Standard Option and wants to switch to Basic Option mid-year C) Subscriber's spouse loses job and is no longer eligible under their own health coverage
Subscriber's spouse loses job and is no longer eligible under their own health coverage
Anna is an FEP member who has Medicare A and B primary and is having inpatient surgery at a Preferred facility. If Medicare denies her claim because the services are not covered, what will FEP pay for the facility charges?
100% of plan allowance with a copy of Medicare denial