Bluecross blueshield - Study guides, Class notes & Summaries

TEST BANK for Understanding Health Insurance: A Guide to Billing and Reimbursement, 2023 Edition 18th Edition Michelle Green TABLE OF CONTENTS 1. Health Insurance Specialist Career. 2. Introduction to Health Insurance and Managed Care. 3. Introduction to Revenue Management. 4. Revenue Management: Insurance Claims, Denied Claims and Appeals and Credit and Collections. 5. Legal Aspects of Health Insurance and Reimbursement. 6. ICD-10-CM Coding. 7. CPT Coding. 8. HCPCS Level II Coding. 9...

What title is listed on the BlueCross BlueShield identification cards for federal employees? - Government-Wide Service Benefit Plan The retrospective review process associated with a utilization management program - reviews medical necessity and appropriateness of medical procedures and services provided as part of claims processing Prior to the joint venture between BlueCross and BlueShield, the BlueShield plans covered only - physician services BlueCross facilities that had signed contr...

Which is required of outpatient physical, occupational, and speech therapy services as part of an OPAP? a. preadmission certification b. precertification c. preadmission testing d. prospective review - precertification Which phrase is located on a Federal Employee Program plan ID card? a. Family, High Option Plan b. Preferred Provider Organization c. Office of Personnel Management d. Government-Wide Service Benefit Plan - Government-Wide Service Benefit Plan Which is a program that req...

For-profit corporations - This corporation pay taxes on profits generated by the corporations enterprises and pay dividends to shareholders on after-tax profits. individuals who don't have access to group plans and small business employers. - BCBS fee-forservice or traditional coverage is selected by.. Nonprofit corporations - Charitable, educational, civic, or humanitarian organizations whose profits are RETURNED to the corporation rather than distributed to shareholders and officers of th...

BCBS indemnity coverage is characterized by certain limitations, including - hospital-only or comprehensive hospital and medical coverage One of the requirements that a participating provider must comply with is to - make fee adjustments for the difference between amounts charged to patients for services provided and payerapproved fees. Which is a program that requires providers to adhere to managed care provisions? - preferred provider network (PPN) One of the expectations that a nonparti...

rider - What is a special clause in an insurance contract that stipulates additional coverage over and above the standard contract? preferred provider network - What is a program that requires providers to adhere to managed care provisions? obtain payment for the full fee charged - One of the expectations that a nonparticipating provider has is to ____ for services rendered. suitcase - The plan ID card for a subscriber who opts for BCBS's Healthcare Anywhere PPO coverage uniquely contain...

Revenue Cycle Management Ch.13 BlueCross BlueShield Practice Questions and Answers One of the requirements that a participating provider must comply with is to a. purchase billing manuals and newsletters published by the payer and pay registration fees to attend payer training sessions. b. make fee adjustments for the difference between amounts charged to patients for services provided and payer-approved fees. c. maintain a provider representative department to assist with billing and pa...

Chapter 13- Bluecross Blueshield insurance Practice Questions and Answers 1929 - Answer️️ -Bluecross began in what year? Baylor University Hospital in Dallas, Texas - Answer️️ -Where did Bluecross begin? 21 days of hospitalization per year for subscribers and their dependents - Answer️️ - How much hospitalization did bluecross originally cover? $6 annual premium - Answer️️ -How much did Bluecross originally cost? Bluecross plan - Answer️️ -The forerunner is known as w...

BlueCross BlueShield Exam Study Guide with Complete Solutions Prior to the joint venture between BlueCross and BlueShield, the BlueShield plans covered only - Answer️️ -physician services BlueCross facilities that had signed contracts to provide services to subscribers for special rates were known as _____ hospitals. - Answer️️ -member In what year was the BlueCross BlueShield Association (BCBSA) created? - Answer️️ -1986 Which is function of the BlueCross BlueShield Associat...

Chapter 13 BlueCross BlueShield Vocabulary and Additional Terms Questions and Answers | 100% Pass Away From Home Care Program - Answer️️ -provides continous BCBS health care coverage for subscribers who will be out of their service area for more than 90 consecutive days BCBS Basic Coverage - Answer️️ -BlueCross BlueShield (BCBS) coverage for the following services: hospitalization, diagnostic laboratory services, x-rays, surgical fees, assistant surgeon fees, obstetric care, inte...