What are 5 SERVICES ROUTINELY INCLUDED IN BCBS BASIC COVERAGE?
100
PALO ALTO, CA
What is WHERE THE FIRST BLUE SHIELD PLAN ORIGINATED?
100
UCR
What is USUAL, CUSTOMARY & REASONABLE
200
ALL PHYSICIANS ARE CONSIDERED PARTICIPATING PROVIDERS ON COMMERCIAL INSURANCE PLANS
What is FALSE?
200
OASIS
What is OUTPATIENT PRETREATMENT AUTHORIZATION PLAN?
200
SPECIAL ACCIDENT INJURY RIDER &
MEDICAL EMERGENCY CARE RIDER
What are 2 RIDERS COMMONLY APPENDED TO THE MAJOR MEDICAL BENEFITS PLAN?
200
BCBS PLANS ORIGINATED AS 2 SEPARATE ENTITIES SELLING THIS TYPE OF HEALTH PLAN
What is PREPAID MEDICAL?
200
IN 1939 THE AHA BECAME THE APPROVING AGENCY FOR THIS
What is ACCREDDITATION OF NEW PREPAID HOSPITAL PLANS
300
WHEN ENTERING A MODIFIER ON THE CMS-1500 CLAIM, SEPARATE THE MODIFIER FROM THE CPT/HCPCS CODE NUMBER BY USING A SPACE RATHER THAN A DASH
What is TRUE
300
SSO
What is SECOND SURGICAL OPINION?
300
A POLICY PURCHASED BY THE SUBSCRIBER THAT USUALLY COVERS THE ANNUAL DEDUCTIBLE AS WELL AS THE CO-PAY OR CO-INSURANCE COSTS OF THE PRIMARY POLICY.
What is COMMERCIAL SUPPLEMENTAL POLICY?
300
WITH MOST BCBS PLANS, POLICYHOLDERS ARE ALSO IDENTIFIED AS THIS:
What are MEMBERS?
300
ORGANIZATION THAT REQUIRES PATIENT TO OBTAIN SERVICES FROM THE NETWORK PROVIDERS OR THEY WILL BE HELD RESPONSIBLE FOR FOR ALL OF THE CHARGES
What is EXCLUSIVE PROVIDER?
400
DEPENDENTS' NAMES ARE PRINTED ON THE FRONT OF A SUBSCRIBER'S FEP CARD.
What is FALSE
400
FEP
What is FEDERAL EMPLOYEE PROGRAM?
400
DASHES & SPACES
What is OMITTED WHEN ENTERING THE ID NUMBER IN BLOCK 1a?
400
1986
What is THE YEAR BC & BS MERGED TO FORM THE BCBSA?
400
IF A SUBSCRIBER FAILS TO ADHERE TO PPO GUIDELINES AND THE PROVIDER'S PAYMENT IS REDUCED, WHO IS RESPONSIBLE FOR THE BALANCE BETWEEN THE PROVIDER'S PAYMENT & THE PPO ALLOWED RATE?
What is THE SUBSCRIBER?
500
OPAP REQUIRES PREAUTHORIZATION OF OUTPATIENT PHYSICIAN, OCCUPATIONAL, AND SPEECH THERAPY SERVICES
What is TRUE?
500
POS
What is POINT OF SERVICE PLAN
500
FEE-FOR-SERVICE, INDEMNITY, MANAGED CARE, HEALTHCARE ANYWHERE, FEDERAL EMPLOYEE PROGRAM, MEDICARE SUPPLEMENTAL PLANS
What are 6 BCBS PROGRAM TYPES?
500
THE HEALTH INSURANCE SPECIALIST SHOULD REBILL ANY BCBS CLAIMS NOT PAID WITHIN THIS TIME FRAME
What is 30 DAYS
500
COORDIANTED HOME HEALTH AND HOSPICE CARE PROVIDES THE MEMBER AN OPTION TO ELECT THIS: