CDHP Terms
Fundamentals of Claims
Diagnosis Codes Procedure Codes
WGS Navigation
WGS Terms
100
True or false:
CDHP =
Consumer Deductible Health Plan
False
Consumer Driven Health Plan
100
A modifier code further defines a _____ code.
a) Procedure
b) Place of Service
c) Revenue
a) Procedure
100
A _________ ________ is a two character code, billed with a procedure code (CPT or HCPCS).
Modifier Code
100
What key should you press when this comes up in WGS?
ESC
100
True or False?
The PCP coordinates ALL of the health care services the member receives.
True
200
The amount a consumer must pay for covered services before the traditional health coverage begins
What am I?
Deductible
200
What are the two most common claim forms?
CMS 1500 And UB-04
200
A diagnosis code is needed on a claim because it plays a part in determining _____.
A) Illness
b) payment
c) benefits
d) coinsurance
c) benefits
200
Which key moves to previous page when multiple pages are on a screen?
F7
200
(You may only bet up to the amount you currently have with your team. The question will be read by the host)
*What is the definition of OAD?*
A dependent child whose age exceeds the maximum eligible age specified in the group contract.
300
Coverage that includes these four components:
· Preventive care
· Other covered services
· Network discounts
· Out-of-pocket maximum
Traditional health coverage or (THC)
300
In most cases what would be submitted with a completed Member Submitted Claim Form?
Itemized bill/statement from provider or receipts
300
True or False?
A procedure code lets you know what condition a patient has been treated for.
False:
Diagnosis Code
300
Which key clears the field?
End
300
A combination plan that offers members access to use both HMO and PPO benefits.
What am I?
Point of Service or (POS)
400
Core claims processing system that was developed to support Service associates with CDHP related questions
What am I?
Lites
400
I am in a institutional health care facility. What claim formed would be used on my behalf?
UB-04
(Also known as the CMS 1450)
400
True or false?
There are five numerical digits in CPT and HCPCS codes
True
400
What does this button do in WGS?
F3
Returns you to the previous page
400
Procedures designed to ensure health care payments are paid appropriately when a second carrier or insurance policy (other party) has financial liability to the member or patient.
What am I?
Coordination of Benefits (COB)
500
What are the CDHP Plan names
*note*
You do not have to say the entire name just the abbreviated name for this question.
HIA, HIA+, HRA AND HSA plans
500
Name the two types of procedure codes
CPT and HCPCS
500
(You may only bet up to the amount you currently have with your team. The question will be read by the host)
*What does the ICD-10 Stand for?
(not the definition)
International Classification of Diseases code-10
500
Which key is used for help or to find out further information?
F1
500
What does the abbreviation of ERISA stand for?
Employee Retirement Income Security Act.