the four basic types of health insurance fall into two broad categories, which are
What is indemnity/managed care
100
A type of HMO whereby services are provided by outpatient networks composed of individual health care providers who supply all necessary patient care is
What is IPA
100
Which organizations is responsible for creating the revised CMS-1500?
What is NUCC/NUBC
100
The 9-digit federal tax id # is commonly referred to as
What is EIN
100
A common cause for insurance claims to be rejected is
What is invalid patient diagnostic code
200
The private not-for-profit organization dedicated to improving health care quality and frequently referred to as the "watch dog" is
What is NCQA
200
Define lifetime insurance cap
What is many FFS policies set a limit for what they will reimburse their members for any charge incurred, which is referred to as
200
The front side of the CMS-1500 is printed in what color and how many blocks
What is red and 33 blocks
200
The two main sections of the CMS-1500 are
What is patient/supplier
200
Identify an important advantage of filing claims electronically
What is it reduces reimbursement time
300
Many self-insured groups hire a specific type of organization to manage and pay claims called
What is Employee retirement services administrators (ERSA), Administrative services organization (ASO)
300
define timely filing
What is PAR providers contracting with BCBS must file claims withing 365 days following the last date of service provided to the patient
300
Specific guidelines for OCR scannable claims include
What is using upper case letters, using 8-digit DOB, using no dollar signs or decimal points
300
One of the health insurance professional's most important responsibility is
What is maximizing reimbursement
300
the primary objective in submitting claims is to
What is submit clean claims
400
The plan types within a managed care plans include who
What is PPO, HMO, POS
400
A private, nonprofit organization that accredits health care plans based on evaluation of high quality of care given to the plan member
What is NCQA
400
If given a birth date, how would you correctly write in block 3 of the CMS-1500
What is MM DD YYYY
400
What should a medical record do?
What is document the healthcare professional's findings
400
under which circumstance is a claim attachment necessary?
What is when an unlisted procedure code is reported
500
Define PPO
What is a group of health care providers working under one umbrella to provide medical services at a discount to the individuals who participate in the plan
500
Define group insurance
What is many Americans obtain health insurance owing to their employment through what?
500
The bottom half of the CMS-1500 is used for what
What is physician/supplier info
500
The patient/insured section of the CMS-1500 includes blocks
What is 1-13
500
patient information is entered on which part of the form