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Benefits
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Precertification
Claims
100
What is the name of the BENEFIT for a SUB BENEFIT called "Office Visit"?
Outpatient Physician
100
What are the 2 things that you mention to the HCP when you access an account in oneview?
Effective date Plan type
100
Mention 2 buttons you use from the AVAYA and explain what they are for
Auto In - Ready to take a phone call Transfer - When you need to transfer the call to another department
100
What is the name of the file that contains all the procedure codes and precert information?
Service Procedure Code Guide
100
Mention the 2 things you need to get from the HCP to access a claim in oneview
DOS Charged Amount
200
Explain what "Apply place of service bounds means"
It means that we have to determine whether a procedure is done in an office or at a facility
200
What is the disclaimer for giving accumulators?
As of to date and still subject to change
200
Mention 3 situations in which your trainer can give you a Warning
Lateness Cellphones inside the class Conduct
200
What are the two types of Medical Management Module?
PHS + PHS
200
What tools do you use for paper or electronic hard copies of a claim?
Xnet Iview
300
Mention 3 sub benefits for Short Term Rehabilitation
Physical Therapy Speech Therapy Cognitive Therapy Occupational Therapy Cardiac Rehab
300
What is preexisting condition, and where do you check if it applies?
Condition that a patient has before having Cigna as insurance company. You check if it applies in BA-Provisions-Preexisting Condition
300
What is the name of the system you use to retrieve all the info from the phone into your computer
CTI
300
What is the difference between PHS and PHS+?
PHS+ is for precertification PHS is for Medical Necessity Reviews
300
What does the remark 0248 mean?
Claim is already processed or finalized
400
Give an explanation for the phrase "Carved Out"
It means that a benefit is handled by a different company
400
Explain the detailed process of checking if a HCP is INN or OON
Open CPF, put the TIN, select TIN and Net Rel, look for the doctor, select the option that matches the patient's network, check if there is a cancelation date
400
Describe 3 things that your trainer likes to do that she has mentioned before in class
Vegetarian Horses Has been in South Africa
400
Will a HCP need precert for a inpatient procedure; code 98941; PHS+
Yes; all inpatient procedures need precertification
400
What are the 4 ways to find a fee schedule?
PPO Screen IDT Screen CPF Provider Maintenance
500
For home health care benefits, does the patient have to be homebound? Explain what that means
No; it means that the patient does not necessarily have to be at his/her house
500
What is COBRA and where do you check if a patient has COBRA?
COBRA is a benefit that allows patients who lost their job to have the same level of benefits that they had when they were working
500
What are all the activities you use and have used before in estart and what they are for
CCT classroom CCT breaks lunch PST classroom PST breaks Clock in/out
500
Explain the 48/96 rule and when does it apply?
Authorization for maternity that does not require precert for the first 48 hrs in a natural delivery or 96 hrs for a C Section
500
Mention all the things you should give to a HCP when checking on claim status?
Status Received and processed date Allowed amt and patient responsibility Payment information (all of them)