The offspring of a dependent child as long as the dependent remains eligible.
Grandchild
100
ID Number: 103270872
What is the deductible and OOP for family?
Family Deductible: $6,400.00
OOP Max: $11,400.00
100
If Jerry is on his mom's Cigna insurance but he also just recently got his insurance through his employer, which plan would be his primary?
His employer's insurance
100
True or False? Can diagnosis code G43.001 be used with procedure code 97813?
True
100
Does diagnosis code S81.049D need precertification?
Yes
200
a significant change in a subscriber's life that effects his or her benefits and allows the subscriber to change benefits outside of an open enrollment period.
Life Status Change
200
The dollar amount accumulated towards the plan’s deductible during the last three months of the plan year which can be credited to the next year’s plan deductible.
Carry Over Deductible
200
This insurance pays for personal injuries suffered by a customer in a motor vehicle accident regardless of fault.
No fault
200
Diagnosis code G72.49 should be billed with which procedure code in order to be covered?
95937
200
When you don't have providers within a reasonable distance of your home, this policy applies.
Network adequacy
300
The method in which the employee submits and updates eligibility information.
Method of Eligibility Transfer
300
A fixed amount where all family members contribute to the same deductible amount with no limit on how much an individual can contribute
Collective Deductible
300
Give 4 examples of when COB would not apply.
Military Insurance
Student Insurance
Medicaid
Dental HMO
IFP
Worker's Comp.
300
True or False? A 2017 claim with procedure code 76800 can be billed with diagnosis code 225.3
False.
300
How many days does a Healthcare Facilitation Center have to determine approval or denial of a precertification?
5 business days
400
A document provides to individuals and employers with standardized information about the plans benefits and coverage.
Summary of Benefits and Coverage
400
Provision which allows any amount contributed to an out-of-network deductible to accumulate towards the in-network deductible and vice versa.
Cross Accumulation
400
Registry of coverage information that will help health plans and health care professionals correctly identify which members have been benefits that should be coordinated and help determine primacy to assist in getting corresponding claims processed correctly the first time.
COB SMART
400
True or False? Procedure code 90660 is a valid procedure code for Influenza virus vaccine for a claim date of 12/25/2016.
False
400
Which steps (in order) can be taken if a service has been denied?
The minimum amount of hours an employee is required to work during a set amount of time in order to be eligible for benefits through the employer.
Active Service Requirement
500
The Customer's coinsurance is 40% and their out of pocket maximum has been met of $3,000.00. If the customer has surgery that costs $15,000.00, how much is the plan going to pay?
Plan will pay 100%.
500
Which rule would apply if Pebbles was the daughter of a veteran who has Tricare?
No rule applies
500
True or False? Diagnosis code E09.40 can billed with procedure code E0765 for Electrical Stimulators.
False
500
ID Number: 102902422
Cholecystitis unspecified was approved for this member on which date and by which physician?