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CLAIMS QUIZ
Professional - Week 1-2
| Question | Answer |
|---|---|
| Where in the FAM would you find Noncovered Procedure Codes? | Exhibit 2 |
| COB Investigation code for when all the money goes to the deductible, copay, and coinsurance? | 12 |
| Where do you go to look at the image of a claim? | DocRequest |
| If the 7th digit on a claim is 7-9, how was the claim received and where do you go for the information? | Electronic, Repository (Business Objects) |
| If the procedure code begins with a "G", or ends with a "F" and .01 was charged, what is the denial? | T502 |
| What are the 3 Assistant Surgeon modifiers? | 80, 81, 82 |
| What is the allowance for Physician Assistant? | 17% |
| What do you do with "L" codes? | Always pend to MED. |
| If the direction of payment is "85", who will recieve the payment? | Provideer |
| When will you see the EOB remark code T059? | When the procedure code begins with "G", and or ends with "F", and there is 0.00 charge. |
| What are two names that describe the claim form submitted by a Provider? | CMS1500 or a HCFA1500 |
| PXPL, is an EOB remark code that you will receive when? | If the provider is part of the CNC/HNS network, and they file to FEP first instead of through the CNC/HNS program. |
| What is the name of the "Bible" for claims processing in FEP, and the "books" of the the Bible called? | The FAM and SOPs. |
| True or False. If Medicare denies a procedure, we must deny since Medicare is Primary? | False, we ONLY deny if its a non-covered service. |
| If a patient has double coverage, Med B. is Secondary, State Blue Cross is Primary...how many EOBs will you need to process their claim and why? | 1, because State is the only insurance that is Primary to FEP. |
| True or False. Diagnosis code is the code used for the services rendered by the physician? | False. It's the Procedure/HCPCS code. |
| True or False. A duplicate claim is a claim that has already been filed that has the same dates of services, but can have different procedure codes? | False, to be a duplicate it must have the same everything. |
| RF1031 and RF1032 are used for what purpose(s). | RF1031 Procedure code definitions, RF1032 Diagnosis code definitions. |
| The most commonly filed POS (Place of Service), on professional claims is what number and what does it mean? | 11, Office Visit |
| The following claim dispositions 9, 1, 2, mean? | 9 - denied, 1- orginal, 2- adjustment |
| PMHS screen PR1032 is used for what purpose? | To check provider status for DOS. |
| When you see PHNF and or HNF on a claim what two SOPs should you always reference? | Venipuncture and Bundling |
| The deferral XI+ is for what type of claims and what do you do with them? | Individual Consideration, pend to MED with comments regarding your procedure code. |
| What are the 3 special non-par provider numbers that will replace CHFEP and their type of service rendered? (Performing Provider only) | FANES - Anesthesia, FEHIT - Home Infusion, AND FEPME - DME |
Created by:
Seabreeze06
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