Regular Claims
When you open up a claim and click “Edit, what is the first thing you should do?
Check Claim Alerts
NSA applies to air ambulance. True or False
False
The assignment on Medicaid claims.
Pay to Plan
This is the coinsurance percentage for Plan 15.
15%
Benedict Cumberbatch plays this Doctor in the Marvel Universe movies.
Doctor Strange
The only authorization on file is denied for a claim, which edit(s) could be used? Be specific.
Deny- Not Medically Necessary or Deny- Investigational/Experimental
NSA stands for this.
No Surprise Act
Are EOBs manually suppressed on Medicaid claims?
No
This plan does not have a $100 ER co-pay.
Plan 18
You may call this Doctor if you cannot figure out what is wrong with an animal.
Doctor Dolittle
What should a processor do on EVERY claim?
Check Claim Alerts
The 2 fee types are used/seen when processing Zelis Received claims.
OON External Pricing and Reasonable and Customary
COB box should contain this on Medicaid claims.
Nothing
These two plans have a co-pay for doctor's visits.
Plan 16 & 17
This Doctor says things like "Why make trillions when we can make billions?" and "Why must I be surrounded by frickin' idiots?". He also has a cat named Mr. Bigglesworth.
Doctor Evil
When is it okay to match an authorization to a claim with a different CPT?
If the code on the claim and the code on the authorization are in the same grouping or the same procedure for the same area of the body.
Verify the amount in the Repriced Allowed Amount column of this and it must match what for each line? (2 part answer)
OON Pricing Report - Allowed Amount
On Medicaid Claims, when do we use billed charges instead of Medicaid paid amount?
When Medicaid paid amount is greater than the billed charge.
This plan has a coinsurance of 10% and a $10 co-pay.
Plan 17
This doctor has no bed side manner and a limp, but will have you diagnosed and fixed up in around 42 minutes.
Doctor Gregory House
A member has a plan deductible of $1000.00 and has already met $576.00 of it. How much more does the member have to pay before insurance benefits are applied?
$424.00
If this is present, the claim can be sent to be repriced at here. (2 part answer)
YA - Zelis
The network and fee type for a Medicaid claim containing ER charges. (2 part answer)
Anthem - Reasonable and Customary
This is the coinsurance percentage for Plan 18.
30%
This Doctor has two hearts.
Doctor Who