MBA Claims Trainee Quiz

The Minimum Quality Goal during live is set to a ____ standard.

• 99%

• 98%

• 97%

• 96%

The Quality Process of LIVE is set to a maximum day timeframe of

• 20 days

• 30 days

• 8 days

• 25 days

Each day of LIVE you will have ___ number of claims audited for quality purposes

• 50

• 15

• 20

• 25

If you successfully maintain a 97% accuracy percentage for 8 rolling and consecutive days, you will be eligible to graduate from the LIVE quality program.

• True

• False

Claims employees are graded using the Customer Experience Program which consists of 13 categories including both technical and customer experience driven performance goals.

• True

• False

Claims employees are assessed for accuracy using the MTM program that consists of dollar, statistical, and procedural quality elements.

• True

• False

Where would you locate claims accuracy guidelines and sampling requirements for BCBST?

• Medical Policy Manual

• FOLH

• MTM Program Guide

• bcbst.com

When reviewing a claim you processed for BCBST the final adjudication showed a payment amount of $125.00. MBA Quality reviewed the claim and determined that OPL amounts were keyed incorrectly causing the claim to pay $125.00 when it should have paid $100.00. This is an example of which type of error?

• Dollar Error - Overpayment

• Stat Error - Underpayment

• Procedural Error - Overpayment

• Dollar Error - Underpayment

When reviewing your claim it was determined that internal claim notes should have been created on this particular claim. There were no claim notes found on the claim that was reviewed. This is an example of what type of error?

• Dollar Error

• Statistical Error

• Procedural Error

• Not an Error

An error was detected on a claim you processed. This error did not affect the claim financially, but affected information on the provider remittance advice & member EOB. What type of error is this?

• Dollar Error

• Statistical Error

• Procedural Error

• Not an Error