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Authored by jessica zalazar
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Professional Development
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27 questions
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1.
MULTIPLE SELECT QUESTION
45 sec • 1 pt
what is the 3 minimum provider information that must be listed in provider appeal
Provider name
Provider contact info
member name
provider tax ID
2.
MULTIPLE SELECT QUESTION
45 sec • 1 pt
which below are examples of disputes that we can accept?
letter to the health plan stating that a claim was filled in a timely manna which includes the minimum info and claim data
EOB with a note of appeal type and claim info included
a completed provider dispute form
a call from the provider to member service
3.
MULTIPLE CHOICE QUESTION
30 sec • 1 pt
how many days do the provider have to submit a dispute to health plan, from the date of the initial decision of the claim?
15
2
356
365
4.
MULTIPLE CHOICE QUESTION
30 sec • 1 pt
how many days does the health plan have to send ack letter, if we received PDR appeal electronic?
15
2
356
365
5.
MULTIPLE CHOICE QUESTION
30 sec • 1 pt
how many days do health plan have to send ack Letter if appeal was received by mail?
15
2
356
365
6.
MULTIPLE SELECT QUESTION
45 sec • 1 pt
Where can the provider get a Provider Dispute Resolution form
On the health plan website
with copy of EOB sent
They are mailed, emailed, or faxed to the provider on request.
7.
MULTIPLE CHOICE QUESTION
30 sec • 1 pt
Which Department at Elevance Health handles the Meet and Confer Process?
Grievances and Appeals
Provider Escalations
member services
legal
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