WHERE BLUE CROSS AND BLUE SHEILD HEADQUARTERS ARE LOCATED
100
I AM THE FINANCIAL CLEARINGHOUSE THAT ALLOWS FOR PLAN FINANCIAL SETTLEMENT AND REIMBURSEMENT
WHO IS THE CFA (CENTRAL FINANCIAL AGENCY)
100
Cost-sharing arrangement in which a member pays a specified fixed dollar amount for a specific service
What is a Co-payment
100
On a CMS-1500 this field holds the rendering provider information
What is field 24J
100
Used to locate Vendor information such as the vendor mailing address (where payments are sent), and view the vendor’s name
What is PR1014-Vendor Maintenance
200
PRESIDENT AND CHIEF EXECUTIVE OFFICER
WHO IS J. BRADLEY (BRAD) WILSON
200
I CONTRACT PROVIDERS TO DELIVER SERVICES TO HOME PLAN MEMBERS
WHO IS THE HOST PLAN
200
The maximum amount of covered services that will be reimbursed on behalf of a member while covered under this health benefit plan
What is a Lifetime Maximum
200
I am a bill type 131 on a UB-04 Claim. I am located in ______ field, billing as a ______ claim
What is Hospital, Outpatient, Admit through discharge claim, located in field 4
200
Used to locate the provider's BCBSNC provider number, locate a provider by Tax ID#, or locate the name of a provider by entering the provider number
What is PR1061-Provider Inquiry
300
QUALITY PRODUCTS, INFORMATION, AND SERVICES TO HELP OUR CUSTOMERS IMPROVE THEIR HEALTH AND WELL-BEING.
WHAT BLUE CROSS AND BLUE SHIELD DELIVERS/OFFERS
300
I CONTROL ALL ASPECST OF THE BENEFIT DELIVERY
WHO IS THE HOME PLAN
300
The process of determining how much money will be paid for a particular claim
What is Adjudication
300
I am CPT code 99213 found in field ______ on a CMS-1500 form
What is field 24D
300
Used to look up the description of a diagnosis code and determine if a diagnosis code is active.
What is RF1032-Diagnosis Maintenance
400
1. Reduce medical cost while improving quality
2. Restructure our administrative costs
3. Diversify our revenues, margins and markets
4. Prepare our organization to compete
5. Re-engineer our business processes and systems
What are BCBSNC enterprise strategies
400
WE ARE AN ASSOCIATION OF BLUE CROSS AND BLUE SHEILD PLANS
WHO IS THE BLUE CROSS AND BLUE SHIELD ASSOCIATION (BCBSA)
400
A form of cost-sharing in which the member must pay a specified percentage of all remaining eligible medical expenses after the deductible has been paid
What is a Coinsurance
400
I am bill type would indicate a final bill per the Medicare Advantage RAP Claim job aid
What is 329
400
Use to look up the description of a procedure code (CPT-4, Revenue, HCPC and ICD-9 Procedure Codes) and used to determine if a procedure code is active
What is RF1031-Service Maintenance
500
CARING, COLLABORATIVE, CREATIVE, COMMITTED
WHAT ARE THE 4 C'S
500
I ENABLE MEMBERS TO OBTAIN HEALTH CARE SERVICES WHILE TRAVELING OR LIVING IN ANOTHER LICENSEE'S SERVICE AREA
WHO IS THE BLUECARD PROGRAM
500
The amount of loss or expense for covered services that must be incurred by an insured before an insurer will assume any liability for all or part of the remaining cost of covered services
What is a Deductible
500
On a CMS-1500 this field holds the billing provider information
What is field 33
500
Used to locate the individual provider’s participation status (POrg), the participation status for an institutional provider (POrg), and the vendor associated with the individual provider
What is PR1013-Provider Contract Maintenance and/or PR1032-Provider Service Attributes