Final Assessment 2

Front

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

Back

Associate Empowerment Guidelines.

Front

Can a member cancel their grievance?

Back

False.

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.

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.

Front

What needs to be completed for an expedited appeal for a 200C plan?

Back

Select the box to acknowledge this is an Expedite.

Front

What is the purpose of the Associate Empowerment Guidelines?

Back

To provide a framework for adjusting claims based on referrals.

Front

What does it mean if a grievance cannot be canceled?

Back

It means once filed, the grievance process must continue until resolved.

Front

What is the Pre-cert Search used for?

Back

To verify prior authorization requirements for CPT codes.

Front

What is a True Prior Inquiry?

Back

A process to confirm if a prior inquiry is valid.

Front

What is the significance of selecting the box to acknowledge an expedited appeal?

Back

It indicates that the appeal process is prioritized due to urgency.