Bcbs new exam - Study guides, Class notes & Summaries

EPO - ...provides benefits to subscribers who are required to receive services from network providers IDS - ...organizations of affiliated providers sites that offer joint healthcare services to subscribers HMO - ...providers comprehensive healthcare services to voluntarily enrolled members on a prepaid basis POS - ...patients can use the managed care panel of providers (paying discounted healthcare cost) or self-refer to out-of-network providers (and pay higher cost) PPO - ...contracted ...

NHA CBCS Certification Practice Exam A Questions with Complete Solutions Which of the following is considered the final determination of the issues involving the settlement of an insurance claim? - ANS: Adjudication - is the process of putting an insurance claim through a series of edits for final determination. Chapter 4 A form that contains charges, DOS, CPT codes, fees, and copayment information is called which of the following? - ANS: Encounter form is a form that contains charges, D...

Mock CPB Exam Practice Questions and Answers Court decisions that establish a standard use legal decisions to serve as authoritative rules or patterns in future similar cases. The legal term for standard is ______. a. decision b. example c. precedent d. statute - ANSWER-precedent Which is established in advance and based on reported health care charges from which a predetermined per diem rate is determined? a. prospective cost-based rate b. retrospective reasonable cost system c. pro...

GBA 1 - Study Guide Questions and Answers Rated A+ What was the purpose of the Health Maintenance Organization Act of 1973? The health maintenance organization action of 1973 provided federal initiatives - consisted of federal grants and loans to organizations wishing to investigate the feasibility of "federally qualified HMO" How did the passage of the Health Maintenance Organization Act of 1973 affect the growth of HMOs? The government began to withdraw its funding during the Reagan adminis...

BCBS NE 2022 Exam Questions with Correct Answer How many counties are in the Blue Cross Blue Shield of Nebraska HMO and PPO plans service area for 2022? A. 76 B. 68 c. 42 D. 82 - Answer-A What tiers of drugs will your client have to pay a deductible before they are covered under the Part D benefit included with the Blue Cross and Blue Shield of Nebraska's Medicare Advantage plans? A. Tiers 1, 2, B. Tiers 1 & 2 C. Tiers 3 D. None of the above. - Answer-C The nurse line offers? ...

BCBS NE 2022 Exam Questions with Correct Answer How many counties are in the Blue Cross Blue Shield of Nebraska HMO and PPO plans service area for 2022? A. 76 B. 68 c. 42 D. 82 - Answer-A What tiers of drugs will your client have to pay a deductible before they are covered under the Part D benefit included with the Blue Cross and Blue Shield of Nebraska's Medicare Advantage plans? A. Tiers 1, 2, B. Tiers 1 & 2 C. Tiers 3 D. None of the above. - Answer-C The nurse line offers? ...

BCBS NE 2022 Exam Questions with Correct Answer How many counties are in the Blue Cross Blue Shield of Nebraska HMO and PPO plans service area for 2022? A. 76 B. 68 c. 42 D. 82 - Answer-A What tiers of drugs will your client have to pay a deductible before they are covered under the Part D benefit included with the Blue Cross and Blue Shield of Nebraska's Medicare Advantage plans? A. Tiers 1, 2, B. Tiers 1 & 2 C. Tiers 3 D. None of the above. - Answer-C The nurse line offers? ...

Medical Billing & Coding as a Career - *Claims assistant professional or claims manager, *Coding Specialist, * Collection Manager, *Electronic Claims Processor, *Insurance Billing Specialist, * Insurance Coordinator, *Insurance Counselor, *Medical Biller, *Medical & Financial Records Manager, * Billing & Coding Specialist What are Medical Ethics? - Standards of conduct based on moral principle. They are generally accepted as a guide for behavior towards pt's, dr's, co-workers, the gov, and...

Medical Billing & Coding as a Career - *Claims assistant professional or claims manager, *Coding Specialist, * Collection Manager, *Electronic Claims Processor, *Insurance Billing Specialist, * Insurance Coordinator, *Insurance Counselor, *Medical Biller, *Medical & Financial Records Manager, * Billing & Coding Specialist What are Medical Ethics? - Standards of conduct based on moral principle. They are generally accepted as a guide for behavior towards pt's, dr's, co-workers, the gov, and...

Place the options below in order of claim submission, where all insurances are relevant. Humana ABC Auto Medicaid Medicare - Answer- ABC Auto Humana Medicare Medicaid It is highly unlikely that a patient would have all four of these insurances. However, if they do, the order in which the claims are submitted is relevant. It is assumed that since there is auto insurance involved, that this claim has to do with an automobile accident. The auto insurance should be filed first. Humana, a pri...