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QUANTUM HEALTH- FINAL EXAM QUESTIONS & ANSWERS SOLVED 100% CORRECT!!
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QUANTUM HEALTH- FINAL EXAM QUESTIONS & ANSWERS SOLVED 100% CORRECT!!
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QUANTUM HEALTH- FINAL EXAM QUESTIONS& ANSWERS SOLVED 100% CORRECT!!
How long does it take for pharmacy claims to process? Answer - Immediately
(Real Time)
Why would a PCP's name in PIVIT be highlighted yellow? Answer - needs
updating or verification
A member calls and tells you that they were just diagnosed with a serious
medical condition that will require surgery and a lot of rehab. They just want to
make sure that is the best and only option that they have. What kind of point
solution would you suggest for them? Answer - Second opinion
What do you call a group of doctors, hospitals, and other healthcare providers
that are contracted to offer their services for a lower than usual rate Answer -
Specialty/Narrow Network
What section of Smart Benefit Search would you go to in order to quote a sick
office visit with a pediatrician Answer - PCP- Office Visit
What does DME stand for? Answer - durable medical equipment
In which section of SBS would you look for information on specific
requirements an employee would need to satisfy in order to get a lower
premium? Answer - Incentive Management Program
, People who have an established relationship with a PCP spend on average ____
less on healthcare Answer - 30
When calling the network to verify whether a provider participates to not,
what are the 3 pieces of information you need to obtain before calling? Answer
- Doctor's name, Facility ( Billing address), and Tax ID
What 3 pieces of information do we need to properly look up a claim Answer -
date of service, amount of claim, and provider name
What are the two main functions of a TPA Answer - Administer the plan and
pay claims
Why does an employer hire a network for their plan Answer - To save money
and provide services at discounted (contracted) rate
When building a Pre-Determination for an office procedure, what provider will
you input in the top right hand corner of the Pre-D? (Physician/Facility field of
the form) Answer - NPI for Preforming Facility
What Benefit would you quote for Botox Injections Answer - Office Surgery
what kind of nurse preforms daily concurrent for inpatient members? Answer -
UR Nurse
At Quantum, How many pieces of information are you required to get from the
member or provider prior to giving out PHI? Answer - 3
What benefit would you quote for a CPAP machine Answer - Durable medical
equipment
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