Appeal Process Flashcard

Appeal Process Flashcard

Assessment

Flashcard

English

12th Grade

Hard

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15 questions

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1.

FLASHCARD QUESTION

Front

What is the purpose of obtaining HIPAA verification during a verbal DOR process?

Back

To ensure compliance with privacy regulations and protect patient information.

2.

FLASHCARD QUESTION

Front

What can happen if an appeal is submitted without the required form or if the verbal DOR process is not properly documented?

Back

The appeal may be closed.

3.

FLASHCARD QUESTION

Front

What does 'Pre-Service' refer to in the context of healthcare services?

Back

It refers to the service type before the member had the service.

4.

FLASHCARD QUESTION

Front

If a member's claim is denied as not medically necessary, what type of request is this considered?

Back

An Appeal.

5.

FLASHCARD QUESTION

Front

What is a Clinical appeal?

Back

It involves a denial where clinical review was involved.

6.

FLASHCARD QUESTION

Front

What is the significance of the verbal DOR process in the appeal process?

Back

It is a necessary step to document the appeal and ensure all required information is collected.

7.

FLASHCARD QUESTION

Front

What does DOR stand for in the context of appeals?

Back

DOR stands for 'Denial of Request'.

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