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Exam (elaborations)

Quantum Health- Final Exam Questions With Correct Answers

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  • Course
  • Quantum Health
  • Institution
  • Quantum Health

Quantum Health- Final Exam Questions With Correct Answers How long does it take for pharmacy claims to process? - answerImmediately (Real Time) Why would a PCP's name in PIVIT be highlighted yellow? - answerneeds updating or verification A member calls and tells you that they were just diagnos...

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  • October 20, 2024
  • 10
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • Quantum Health
  • Quantum Health
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©SIRJOEL EXAM SOLUTIONS
10/7/2024 11:03AM



Quantum Health- Final Exam Questions
With Correct Answers


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

, ©SIRJOEL EXAM SOLUTIONS
10/7/2024 11:03AM


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

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