Medical Insurance Chapter 13th BlueCross BlueShield Exam Study Guide with Complete Solutions
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Course
Bluecross Blueshield
Institution
Bluecross Blueshield
Medical Insurance Chapter 13th
BlueCross BlueShield Exam Study
Guide with Complete Solutions
One of the requirements that a participating provider must comply with is to -
Answer️️ -make fee adjustments for the difference between amounts charged to
patients for services provided and payer-...
Medical Insurance Chapter 13th
BlueCross BlueShield Exam Study
Guide with Complete Solutions
One of the requirements that a participating provider must comply with is to -
Answer✔️✔️-make fee adjustments for the difference between amounts charged to
patients for services provided and payer-approved fees.
Which is a program that requires providers to adhere to managed care provisions? -
Answer✔️✔️-preferred provider network (PPN)
One of the expectations that a nonparticipating provider has is to _____ for services
rendered. - Answer✔️✔️-obtain payment for the full fee charged
Which is considered a minimum benefit under BCBS basic coverage? - Answer✔️✔️-
hospitalizations
Which is considered a service reimbursed by BCBS major medical coverage? -
Answer✔️✔️-mental health visits
Which is a special clause in an insurance contract that stipulates additional coverage
over and above the standard contract? - Answer✔️✔️-riders
BCBS indemnity coverage is characterized by certain limitations, including - Answer✔️✔️-
hospital-only or comprehensive hospital and medical coverage
Prospective authorization or precertification is a requirement of the _____ BCBS
managed care plan. - Answer✔️✔️-outpatient pretreatment authorization
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