Centene Jeopardy 2025

Denials

100

What is the denial and the process for Same or Multiple Providers Billing Exact or Similar Code(s)?

Denial code EXyQ indicates that the denial is for one of the following reasons:

• Same provider billed for a similar charge (or charges) on the same date of service on a different claim.
• A different physician or facility billed for the same or similar charge (or charges) on the same date of service.

Go to Amisys and view claims by member (IQ1300).

• Search by specific date or date range (depending on the denied claim).
• Look for another claim with the same physician or facility for that same date of service.

200

 Service Not Covered for BHSO what are we checking with this denial?

• If there is primary insurance, advise the provide and how long the primary insurance has been in effect.
  • If the claim is a medical and not behavioral health, advise the provider to bill the primary insurance if any or can contact the member to see if they have any other medical coverage.
  • If the claim is behavioral health, review the HCA Mental Health Billing grid to determine if the claim should have been billed to HCA/ProviderOne.

300

What is the process for this denial?  – Benefit Maximum Has Been Reached (Exceeds Benefit Limit)

• Review the applicable HCA billing guide for quantity limits and time frame (i.e., one every six months, two per visit, etc.).
  • Ensure you are reviewing the correct billing guide for the date of service.
  • 
    
    • Provide the information to the caller and where it can be located (be specific).
    • Pull up Claim by member in Amisys (IQ1300) and search by applicable date/date range (based on billing guidelines) and procedure code.
    • Advised the caller of the number of claim(s) that were received and processed with the search criteria used.
    • If the provider feels that the billed code is accurate and payable than advise them to submit a reconsideration with medical records.

400

How would you check to see if an Npi is registered with the HCA? 

 reference the Provider Affiliation (Run Screen PR0004). If the payclass is WADENYP1, the NPI for the provider has not been registered/updated.

• The payclass can be seen on the OMNI screen for the claim for what pay class was applied to the claim. Looking up the affiliation in either Portico or Amisys will show what payclass has been updated to if changed since claim applied.

500

What is the meaning of this denial? 

Potential Preventable Readmissions Submit all Medical Records

If a member readmits with the same diagnosis or similar and within 14 days of the first admission (within the same hospital/hospital systems, i.e., CHI Franciscan, UWMC);

Music

100

What famous rapper goes by the nickname K. Dot?

Kendrick Lamar

200

What guitarist played on Michael Jackson’s 1983 song “Beat It”?

Eddie Van Halen

300

What City are the Beetles from ?

Liverpool

400

what is the best-selling album of all time from a female artist?

The best-selling album of all time from a female artist is the soundtrack to the movie The Bodyguard, featuring Whitney Houston and various artists. The album has sold an estimated 45 million copies worldwide

500

what are the 3 big music record labels? 

Universal Music Group, Sony Music, and Warner Music Group

Summer

100

What does SPF stand for in sunscreen?

Sun Protection Factor

200

Which flower symbolizes the summer season?

Sunflower

300

What are the United States’ three hottest states?

Florida, Hawaii, and Louisiana. 

 

400

What are the three zodiac signs that occur during summer?

Cancer Leo and Virgo

500

Which U.S. national monument gets over a million visitors in the summer

Mount Rushmore

Amisys Run screens

100

Where would you check for the member's Eligibility?

IQ0800

200

Where would you find the description of an unbundling denial ?

RF0165

300

Where can I see all claims attached to a check?

IQ1500

400

Where would you check to see all the claims processed under a specific authorization?

IQ1100

500

Where can I check for the member's other insurance history? Not the current other insurance the history of all other coverage.

IQ3310

Movies

100

What are the main 3 Minions’ names? 

Stuart, Kevin, Bob

200

 Complete the following movie quote: “Where we’re going, we don’t need ______.”

Roads ( Back to the Future)

300

What did Monsters, Inc. use as their catchphrase?

We scare because we care

400

What is the main character’s name in the “The Godfather” movie?

Michael Corleone

500

Which summer blockbuster was the first to make $100 million at the U.S. box office?

JAWS