What guidelines allow for a claim adjustment if a member was referred to an out-of-network lab by an in-network provider?
Final Assessment 2

Flashcard
•
English
•
8th Grade
•
Hard
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15 questions
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1.
FLASHCARD QUESTION
Front
Back
Associate Empowerment Guidelines.
2.
FLASHCARD QUESTION
Front
Can a member cancel their grievance?
Back
False.
3.
FLASHCARD QUESTION
Front
Where can you verify if a CPT code requires prior authorization when your benefit quote indicates one may be required?
Back
Pre-cert Search.
4.
FLASHCARD QUESTION
Front
Is it true that to mark a True Prior Inquiry, you only have to click Yes on the True Prior Inquiry process?
Back
False.
5.
FLASHCARD QUESTION
Front
What needs to be completed for an expedited appeal for a 200C plan?
Back
Select the box to acknowledge this is an Expedite.
6.
FLASHCARD QUESTION
Front
What is the purpose of the Associate Empowerment Guidelines?
Back
To provide a framework for adjusting claims based on referrals.
7.
FLASHCARD QUESTION
Front
What does it mean if a grievance cannot be canceled?
Back
It means once filed, the grievance process must continue until resolved.
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