Show:
ASO
IGO
Hmmm Good Luck
ASO,IGO, IBO?
Claims
100
True or False: Single employee plans are not subject to state insurance laws?
What is: True! The employer group makes coverage decisions within certain legal parameters.
100
Medium groups have how many employees?
What is :51-99
100
HCPCS? What does it mean??
What is: Health Care Common Procedure Coding System
100
60 days to add newborn to policy?
What is: IBO
100
Manual/ Paper claims start with what? In Facets?
What is : K
200
Abbreviation meaning of MEWA?
What is: Multiple Employer Welfare Arrangement
200
This is the most versatile plan allowing members to see any provider anywhere, as long as the local Provider participates w the local BCBSNC plan.
What is: PPO---- Blue Options
200
DAILY DOUBLE!!!!! The Maximum amount that you are required to pay in a benefit period, before you receive benefits at 100% of covered services?
What is : OOP Limit
200
With _____ BCBSNC determines how much it "would" have paid if it were the primary insurance?
What is : MOB
200
A ______ is a collection of similar documents prepared for imaging or scanning.
What is : a Batch
300
True or False: HMO only allows INN Providers in State, and No OOS services are covered?
What is: False! OOS covers only Urgent Care or ER
300
What is the exception for a dependent being over 26 and remaining on the policy.
What is : Mentally Or Physically Disabled
300
Where would you go to research diagnosis codes in Power?
What is : RF1032
300
Daily Double!!!! This is a first dollar ( pre-deductible) coverage for a defined list of preventive Care Services...?
What is : Enhanced Preventative
300
CMS 1500, UB04, and Subscriber are all types of_____ Claims
What is : Paper
400
What are the 3 current Mewa Groups??
What is: NC Medical Society, Nc Bar Association, State Health Plans
400
This plan is Tiered, and based on the Tier decides how benefits are quoted.. Whats the plan name?
What is : Blue Options 123
400
What extension would you transfer an OOS claim?
What is: ext 37469
400
These plans can be customized..?
What is : ASO
400
What is the POS for code for hospice? and mobile unit? Must answer both.
What is : Hospice 34, Mobile Unit 15
500
What is the Company # for State PPO Plans?
What is: 04
500
True Or False: IGO may require waiting a period?
What is : True! (i.e 30-90 day probation period)
500
If we don't abide by one of the 6 options within 30 calendar days, upon receiving a claim. We must pay an interest penalty & Pay the provider.. Other departments have different time frames.. Name at least 2 others.
What is :1) Performance Guarantee Groups are usually 14 days 2) State PPO 25 days 3) Insured Claims 28 days 4) Nc Health Choice is exempt, but still held to the 30 day standard.
500
True or False: Provider & Billing Provider (vendor) must be associated with each other?
What is : True
500
Member has hold code DC, and wants to know what it means... is it denial or informational.
What is : Cosmetic Review