Claims Upskill

What are the 5Ws?

• How, What , Where, Why, When

• Here, What, Where, Why, When

• Whom, What, Where, Why, When

• What, Where, When, Why, Who

This is claim form is used by professional providers

• CMS 1500

• UB04

• Member Submitted Claim

• International claim form

This claim form is used when a member has medical services on a cruise ship.

• CMS 1500

• UB04

• Member Claim form

• International Claim form

When filing a claim for a member you are able to take the information via phone and place it in the correct spaces.

• True

• False

You must be able to locate a claim form and itemized statement in order to file a claim for a member in Solution Central.

• True

• False

How do you determine if a claim is preventive?

• Code Items

• Cold Beverage

• Code Details

• Code lookup

A procedure that does not need a preventive diagnosis code will appear as _____ in the code details

• HCR ObamaCare

• HCR Preventive W/All DX

• HCR Preventive DX Specific

• HCR Preventive ALL

A procedure that needs a specific preventive diagnosis code will appear as _____ in the code details

• HCR Preventive W/ All DX

• HCR Preventive DX Specific

• HCR Comparison List

• HCR Preventive Specific Diagnosis

The member would need to file an International Claim form if they had services in Jamaica

• True

• False

If a member has services from an OON provider, any payment from Anthem will be made directly back to the same member.

• True

• False